Advertisement

Herz

, 36:600 | Cite as

Therapie der chronischen Herzinsuffizienz durch kardiale Kontraktionsmodulation (CCM)

Möglichkeiten und Studienübersicht
  • T. TönnisEmail author
  • K.-H. Kuck
Schwerpunkt/CME
  • 291 Downloads

Zusammenfassung

CCM („cardiac contractility modulation“) ist eine elektrische Stimulationsform, die im Rahmen der Therapie der systolischen Herzinsuffizienz eingesetzt wird. Sie kann durch eine nichtexzitatorische Stimulation in der absoluten Refraktärperiode der Herzerregung über eine Beeinflussung des Kalziumstoffwechsels der Myokardzellen die Kontraktionskraft steigern. Dies führt zu einer Besserung der maximalen Sauerstoffaufnahme, der Lebensqualität und der Belastbarkeit der herzinsuffizienten Patienten. Die CCM-Therapie wird zusätzlich zu einem eventuell vorhandenen ICD-System durchgeführt. Aufgrund bisheriger Studiendaten wird die Therapie empfohlen für Patienten mit einer linksventrikulären Ejektionsfraktion (LVEF) von höchstens 35% und einer trotz optimaler medikamentöser Therapie symptomatischen Herzinsuffizienz (NYHA-Klasse II–III). Vorhofflimmern, eine höhergradige Extrasystolie und ein AV-Block von mehr als 300 ms sind Kontraindikationen. Bei Patienten mit einem Linksschenkelblock über 120 ms sollte zuerst die Indikation zur Implantation eines biventrikulären ICD-Systems geprüft werden.

Schlüsselwörter

Kardiale Kontraktionsmodulation Chronische Herzinsuffizienz Elektrische Herzinsuffizienztherapie 

Treating congestive heart failure with cardiac contractility modulation (CCM)

Possibilities and study overview

Abstract

Cardiac contractility modulation (CCM) is a device therapy for patients with systolic heart failure. CCM therapy applies non-excitatory signals during the absolute refractory period of the heart cycle. It influences myocardial contractility by modulating the regulation of calcium cycling. CCM therapy has been proven to enhance peak VO2, quality of life and exercise tolerance in patients with congestive heart failure. It can be used as an additional therapy to an implantable cardioverter defibrillator (ICD), if present. CCM therapy should be considered in symptomatic patients with congestive heart failure, a left ventricular ejection fraction ≤35% and NYHA class II–III. Atrial fibrillation, high grade arrhythmias and an AV block of more than 300 ms represent contraindications. Patients with a left bundle branch block of >120 ms should be considered for the implantation of a biventricular ICD prior to implantation of a CCM device.

Keywords

Cardiac contractility modulation Chronic congestive heart failure Electrical heart failure therapy 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Bristow MR, Saxon LA, Boehmer J et al (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350(21):2140–2150PubMedCrossRefGoogle Scholar
  2. 2.
    Cleland JG, Daubert JC, Erdmann E et al (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352(15):1539–1549PubMedCrossRefGoogle Scholar
  3. 3.
    Moss AJ, Hall WJ, Cannom DS et al (2009) Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 361(14):1329–1338PubMedCrossRefGoogle Scholar
  4. 4.
    Daubert C, Gold MR, Abraham WT et al (2009) Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insight from the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial. J Am Coll Cardiol 54(20):1837–1846PubMedCrossRefGoogle Scholar
  5. 5.
    Sandhu R, Bahler RC (2004) Prealence of QRS prolongation in a community hospital cohort of patients with heart failure and its relation to left ventricular systolic dysfunction. Am J Cardiol 93:244–246PubMedCrossRefGoogle Scholar
  6. 6.
    Butter C, Wellnhofer E, Schlegl M et al (2007) Enhanced inotropic state of the failing left ventricle by cardiac contractility modulation electrical signals is not associated with increased myocardial oxygen consumption. J Card Fail 13(2):137–142PubMedCrossRefGoogle Scholar
  7. 7.
    Winter J, Brack KE, Ng GA (2011) Cardiac contractility modulation in the treatment of heart failure: initial results and unanswered questions. Eur J Heart Fail 13(7):700–710PubMedCrossRefGoogle Scholar
  8. 8.
    Imai M, Rastogi S, Gupta RC et al (2007) Therapy with cardiac contractility modulation electrical signals improves left ventricular function and remodeling in dogs with chronic heart failure. J Am Coll Cardiol 49(21):2120–2128PubMedCrossRefGoogle Scholar
  9. 9.
    Butter C, Rastogi S, Minden HH et al (2008) Cardiac contractility modulation electrical signals improve myocardial gene expression in patients with heart failure. J Am Coll Cardiol 51(18):1784–1789PubMedCrossRefGoogle Scholar
  10. 10.
    Gupta RC, Mishra S, Rastogi S et al (2009) Ca2+-binding proteins in dogs with heart failure: effects of cardiac contractility modulation electrical signals. Clin Transl Sci 2(3):211–215PubMedCrossRefGoogle Scholar
  11. 11.
    Yu CM, Chan JY, Zhang Q et al (2009) Impact of cardiac contractility modulation on left ventricular global and regional function and remodelling. J Am Coll Cardiol Img 2(12):1341–1349Google Scholar
  12. 12.
    Pappone C, Rosanio S, Burkhoff D et al (2002) Cardiac contractility modulation by electric currents applied during the refractory period in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 90(12):1307–1313PubMedCrossRefGoogle Scholar
  13. 13.
    Stix G, Borggrefe M, Wolpert C et al (2004) Chronic electrical stimulation during the absolute refractory period of the myocardium improves severe heart failure. Eur Heart J 25(8):650–655PubMedCrossRefGoogle Scholar
  14. 14.
    Borggrefe MM, Lawo T, Butter C et al (2008) Randomized, double blind study of non-excitatory, cardiac contractility modulation electrical impulses for symptomatic heart failure. Eur Heart J 29(8):1019–1028PubMedCrossRefGoogle Scholar
  15. 15.
    Kadish A, Nademanee K, Volosin K et al (2011) A randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure. Am Heart J 161:329–337PubMedCrossRefGoogle Scholar
  16. 16.
    Abraham WT, Nademanee K, Volosin K et al (2011) Subgroup analysis of a randomized controlled trial evaluatioin the safety and efficacy of cardiac contractility modulation in advanced heart failure. J Card Fail (in press)Google Scholar
  17. 17.
    Burkhoff D, Kadish A, Abraham WT et al (2010) Impact of cardiac contractility modulation on exercise tolerance and quality of life in patients with EF greater than 35%: a subgroup analysis of the FIX-HF-5 study. ESC 2010, poster presentationGoogle Scholar
  18. 18.
    Nägele H, Behrens S, Eisermann C (2008) Cardiac contractility modulation in non-responders to cardiac resynchronisation therapy. Europace 10(12):1375–1380PubMedCrossRefGoogle Scholar

Copyright information

© Urban & Vogel, Muenchen 2011

Authors and Affiliations

  1. 1.Abt. KardiologieAsklepios Klinik St. GeorgHamburgDeutschland

Personalised recommendations