Timing of Cardiac Contractility Modulation Therapy Implementation

Symptomatic chronic heart failure (HF) despite medical treatment can be addressed with cardiac contractility modulation (CCM) therapy, which has yet to have been investigated regarding outcome differences between early versus late implementation.

CCM recipients from the Mannheim Cardiac Contractility Modulation Observational Registry (MAINTAINED) aged ≤ 70 years at implantation were grouped with regard to implantation time after the first diagnosis of CCM indicating HF (New York Heart Association classification (NYHA) ≥ 2 and left ventricular ejection fraction (LVEF) = 25%-45%) into either Early- (EC, n = 50, implantation < 13 months after diagnosis) or Late-Implantation Group (LC, n = 81, implantation ≥ 13 months after diagnosis). Both groups were compared regarding survival, NYHA, LVEF, and HF-related hospitalizations for up to 60 months. The mean implantation time after the first diagnosis were 5.85 ± 3.1 versus 92 ± 70.2 months (first values EC, p < 0.05). Mean survival was better for EC (55.2 ± 1.7 vs. 52.8 ± 1.6 months, p < 0.05). Improvements in NYHA (2.98 ± 0.47 to 2.0 ± 0.73 vs. 3.01 ± 0.46 to 2.25 ± 0.8, both p < 0.05) and LVEF (23.2 ± 7.5 to ± 38.82 ± 12.85 vs. 23.9 ± 7 to 29.92 ± 8.9%, each p < 0.05) were comparable, with differences in terms of grouping. Hospitalizations due to HF were more frequent to LC patients (39 vs. 110 events, Odds Ratio 2.1).

Heart failure patients might experience improvements in functional status and left ventricular reverse remodeling following CCM therapy, regardless of the timing of implantation. Early implementation of CCM within the first year of CCM suitable HF might provide additional benefits regarding survival, left ventricular systolic recovery and protection against heart failure hospitalizations.