"Optimizing" the Anesthetic for Cardiac Contractility Modulation Devices

We present a case report of a patient undergoing implantation of a cardiac contractility modulation (CCM) device. The Optimizer^® Smart Implantable Pulse Generator (Impulse Dynamics, Orangeburg, NY, USA) provides electrical energy to the right ventricular septum to modulate cardiac contractility and improve cardiac function in heart failure patients. The non-excitatory electrical signals are delivered by transvenous leads during the refractory period. Anesthetic administration during implantation can affect appropriate lead positioning. Propofol at high doses can attenuate diaphragmatic contraction and discomfort from inappropriate lead positioning, resulting in diaphragm stimulation. Therefore, local or conscious sedation is preferred during CCM device implantation. In patients undergoing procedures with this CCM device in situ, the Optimizer^® activity causes upward deflections of the RS segment on the electrocardiogram. Also, strong electromagnetic fields can disrupt device function. This case report reviews the novel CCM device and its major anesthetic considerations.