Device-therapy in chronic heart failure: Cardiac contractility modulation versus cardiac resynchronization therapy
Goekhan Yuecel1,2, Leo Gaasch1, Abbass Kodeih1
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
ESC Heart Failure
|September 30, 2024
Summary
Cardiac resynchronization therapy with defibrillator (CRT-Ds) and cardiac contractility modulation (CCMs) offer comparable functional improvements for heart failure patients. However, CCM patients experienced higher hospitalization rates, potentially due to more advanced heart failure at implantation.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac implantable electrical devices (CRT-Ds, CCMs) are options for symptomatic heart failure (HF) with reduced left ventricular ejection fraction (LVEF) despite optimal medical treatment.
- A direct comparison between CRT-Ds and CCMs has not been previously established.
Purpose of the Study:
- To compare the efficacy and outcomes of CRT-Ds versus CCMs in patients with symptomatic heart failure and reduced LVEF.
- To evaluate changes in New York Heart Association (NYHA) classification, LVEF, tricuspid annular plane systolic excursion (TAPSE), and QRS-width after 12 months.
Main Methods:
- Retrospective analysis of patients receiving CRT-Ds (n=220) or CCMs with defibrillators (n=105) between 2012 and 2021.
- Comparison of baseline characteristics and 12-month follow-up data including NYHA, LVEF, TAPSE, and QRS-width.
- Analysis of heart failure hospitalization rates.
Main Results:
- CCM patients had lower baseline LVEF and worse NYHA classification compared to CRT-D patients.
- Both CRT-Ds and CCMs showed comparable improvements in NYHA, LVEF, and TAPSE at 12 months.
- HF hospitalizations were significantly higher in CCM patients (45.7%) compared to CRT-D patients (16.8%).
Conclusions:
- Both CRT-Ds and CCMs provide comparable functional status and ventricular reverse remodeling improvements in heart failure patients at 12 months.
- Higher HF hospitalization rates in CCM patients may be attributed to their more advanced HF at the time of implantation.
- Appropriate implantation of CCMs and CRT-Ds can lead to similar positive outcomes in selected heart failure patients.
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