How many patients with heart failure are eligible for cardiac contractility modulation therapy?

Abstract

Background Increasing evidence exists suggesting that cardiac contractility modulation therapy (CCM) improves symptoms in heart failure patients if various selection criteria are fulfilled. The aim of this study is to analyse an unselected sample of heart failure patients to establish what percentage of patients would meet the current criteria for CCM therapy. Methods All patients admitted to two district general hospitals in the UK in 2018 with a diagnosis of heart failure were audited for eligibility for CCM therapy. The selection criteria were (a) ejection fraction (EF) 25%‐45%, (b) QRS duration less than 130 ms, (c) New York Heart Association (NYHA) class 3‐4 and (d) treated for heart failure for at least 90 days and on stable medications. Exclusion criteria included: (a) significant valvular disease, (b) permanent or persistent atrial fibrillation, (c) biventricular pacing system implanted or QRS duration more than 130 ms and (4) patients not suitable for device therapy as a result of palliative treatment intent. Results A total of 475 patients were admitted with heart failure during the study period. From this group, 24 (5.1%) patients fulfilled the criteria for CCM therapy. The mean age and ejection fraction were 70.8 ± 10.2 and 32.5% ± 7.4%. The majority of patients were men (71%) and had an ischaemic cardiomyopathy (75%). If patients with atrial fibrillation were included, an additional 18 (3.8%) patients potentially may be eligible for CCM. Conclusion Only 5.1% of all patients presenting with heart failure might benefit from cardiac CCM. This is a small proportion of the overall heart failure population. However, this population has no other current option for device therapy of their condition.

Enhancing myocardial function with cardiac contractility modulation: potential and challenges

“…Initially, designed for treating patients with sinus rhythm and narrow QRS, CCM has expanded its applications to include those suffering from atrial fibrillation (AF) and patients with wide QRS that do not respond to CRT 16 . Patients can be considered for CCM therapy if they meet the following criteria: (a) ejection fraction (EF) between 25% and 45%; (b) QRS duration less than 130 ms, ; (c) New York Heart Association (NYHA) class 3 or 4; and (d) history of HF treated with stable medications for at least 90 days 30 . However, patients with significant valvular disease, permanent or persistent AF, use of a biventricular pacemaker, QRS duration exceeding 130 ms, or those undergoing palliative treatment are not suitable candidates for CCM therapy 30 .…”

“…Patients can be considered for CCM therapy if they meet the following criteria: (a) ejection fraction (EF) between 25% and 45%; (b) QRS duration less than 130 ms, ; (c) New York Heart Association (NYHA) class 3 or 4; and (d) history of HF treated with stable medications for at least 90 days 30 . However, patients with significant valvular disease, permanent or persistent AF, use of a biventricular pacemaker, QRS duration exceeding 130 ms, or those undergoing palliative treatment are not suitable candidates for CCM therapy 30 . CCM has proven to be safe and effective for patients with a narrow QRS (approximately 130 ms), EF between 25% and 45%, and moderate‐to‐severe symptomatic HF with EF of 25–45% 29 .…”

“… 30 However, patients with significant valvular disease, permanent or persistent AF, use of a biventricular pacemaker, QRS duration exceeding 130 ms, or those undergoing palliative treatment are not suitable candidates for CCM therapy. 30 CCM has proven to be safe and effective for patients with a narrow QRS (approximately 130 ms), EF between 25% and 45%, and moderate‐to‐severe symptomatic HF with EF of 25–45%. 29 Additionally, recent case studies suggest that CCM may benefit patients with AF and wide QRS (>130 ms).…”

Assessment of the implementation of medical and device therapy in heart failure with reduced ejection fraction

“…We found that 5.2% (n=33) of our patients met the indication criteria, and about one-third (n=10) of them would be eligible for a CCM as a second device additional to another cardiac implantable electronic device implanted previously. In the analysis of Dulai et al 5.1% of the examined cohort of hospitalized HF patients were suitable for CCM therapy 135 . A previous review article from Abi-Samra estimated that 79% of patients with NYHA II-III and LVEF<35% could be eligible for CCM 136 .…”