Does Cardiac Contractility Modulation Therapy Reduce Atrial Fibrillation Burden?

Cardiac contractility modulation (CCM) is an implantable technology approved by the U.S. Food and Drug Administration and intended for heart failure patients without a cardiac resynchronization therapy indication. CCM leads to reduced heart failure hospitalizations and improvements in exercise tolerance and quality of life. There are a lack of data examining the impact of CCM therapy on atrial fibrillation (AF) burden. We report the case of a 65-year-old man with a history of paroxysmal AF, hypertension, hyperlipidemia, and carotid artery stenosis who presented with newly diagnosed ischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 20%-25%. He underwent coronary artery bypass graft surgery for triple vessel disease with an improvement in LVEF to 40% after 4 months of guideline-directed medical therapy. Due to clinical heart failure and paroxysms of AF, he underwent CCM device and implantable loop recorder (ILR) implantation. His LVEF improved to 60%, and the ILR showed no AF. We postulate multiple mechanisms to explain the negligible burden of AF.