Kardiale Kontraktilitätsmodulation

Die Kardiale Kontraktilitätsmodulation (CCM) ist eine Device-basierte elektrische Therapieform zur additiven Behandlung der chronischen medikamentös therapierefraktären Herzinsuffizienz. Hochamplitudige Signale während der absoluten Refraktärphase induzieren über multiple Mechanismen inklusive Modifikationen der Genexpression und Beeinflussung myokardialer Schlüsselproteine eine Steigerung der Kontraktilität. Aktuell sind weltweit > 2000 CCM-Devices erfolgreich implantiert. In randomisierten Studien wurde eine Verbesserung der Belastungskapazität und der Lebensqualität nachgewiesen. Für Patienten mit therapierefraktärer Herzinsuffizienz und schmalem QRS-Komplex ist CCM momentan außerhalb von Studien die einzige additive elektrische Therapieoption in Deutschland. Erstmalig erfolgte aktuell eine Berücksichtigung in den neuen Guidelines der Herzinsuffizienz. Prognostische Daten zur Mortalität liegen als Fallserien vor, aktuell laufen diesbezüglich randomisierte Studien bzw. Register.

Cardiac Contractility Modulation (CCM) is a device-based electrical therapy for the treatment of refractory heart failure symptoms. CCM signals are relatively high intensity, nonexcitatory signals applied during the absolute refractory period that have been shown to enhance the strength of left ventricular (LV) contraction and improve exercise tolerance and quality of life. The mechanisms of action appear to involve effects on myocardial gene expression and on normalization of myocardial key-proteins. So far, more than 2000 CCM devices have been implanted worldwide. For patients with symptomatic heart failure and narrow QRS complex CCM is the only additive electrical therapy which had been approved in Germany. Actually for the first time CCM has been referenced in the current Heart Failure Guidelines. Prognostic data with regards to mortality have been evaluated in case series. Ongoing randomized trials and registries will address these specific endpoints.

Key words

Cardiac Contractility Modulation (CCM) - refractory heart failure symptoms - device-based electrical therapy - Heart Failure Guidelines

• Literatur

• 1 Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129-2200
• 2 Butter C, Rastogi S, Minden HH et al. Cardiac contractility modulation electrical signals improve myocardial gene expression in patients with heart failure. J Am Coll Cardiol 2008; 51: 1784-1789
• 3 Yu CM, Chan JY, Zhang Q et al. Impact of cardiac contractility modulation on left ventricular global and regional function and remodeling. JACC Cardiovascular Imaging 2009; 2: 1341-1349
• 4 Butter C, Wellnhofer E, Schlegl M et al. Enhanced inotropic state of the failing left ventricle by cardiac contractility modulation electrical signals is not associated with increased myocardial oxygen consumption. J Card Fail 2007; 13: 137-142
• 5 Goliasch G, Khorsand A, Schutz M et al. The effect of device-based cardiac contractility modulation therapy on myocardial efficiency and oxidative metabolism in patients with heart failure. Eur J Nucl Med Mol Imaging 2012; 39: 408-415
• 6 Borggrefe MM, Lawo T, Butter C et al. Randomized, double blind study of non-excitatory, cardiac contractility modulation electrical impulses for symptomatic heart failure. Eur Heart J 2008; 29: 1019-1028
• 7 Kadish A, Nademanee K, Volosin K et al. A randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure. Am Heart J 2011; 161: 329-337 e1–2
• 8 Abraham WT, Nademanee K, Volosin K et al. Subgroup analysis of a randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure. J Card Fail 2011; 17: 710-717
• 9 Myers J, Goldsmith RL, Keteyian SJ et al. The ventilatory anaerobic threshold in heart failure: a multicenter evaluation of reliability. J Card Fail 2010; 16: 76-83
• 10 Kuschyk J, Roeger S, Schneider R et al. Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients. Int J Cardiol 2015; 183: 76-81
• 11 Kloppe A, Lawo T, Mijic D et al. Long-term survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS duration. Int J Cardiol 2016; 209: 291-295
• 12 Liu M, Fang F, Luo XX et al. Improvement of long-term survival by cardiac contractility modulation in heart failure patients: A case-control study. Int J Cardiol 2016; 206: 122-126
• 13 Nagele H, Behrens S, Eisermann C. Cardiac contractility modulation in non-responders to cardiac resynchronization therapy. Europace 2008; 10: 1375-1380
• 14 Kuschyk J, Stach K, Tulumen E et al. Subcutaneous implantable cardioverter-defibrillator: First single-center experience with other cardiac implantable electronic devices. Heart Rhythm 2015; 12: 2230-2238
• 15 Kuck KH, Bordachar P, Borggrefe M et al. New devices in heart failure: an European Heart Rhythm Association report: developed by the European Heart Rhythm Association; endorsed by the Heart Failure Association. Europace 2014; 16: 109-128