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Kardiale Kontraktilitätsmodulation

Cardiac contractility modulation

Der Internist volume 59, pages 1021–1027 (2018)Cite this article

Zusammenfassung

Die kardiale Kontraktilitätsmodulation (CCM) ist eine Device-basierte elektrische Therapieform zur additiven Behandlung der chronischen medikamentös therapierefraktären Herzinsuffizienz. Hochamplitudige Signale werden während der absoluten Refraktärphase appliziert und induzieren über multiple Mechanismen inklusive Modifikationen der Genexpression und Beeinflussung myokardialer Schlüsselproteine eine Steigerung der Kontraktilität. Aktuell sind weltweit >3500 CCM-Devices erfolgreich implantiert worden. In randomisierten Studien wurden eine Verbesserung der Belastungskapazität und der Lebensqualität sowie eine Verbesserung linksventrikulärer Parameter nachgewiesen. Für Patienten mit therapierefraktärer Herzinsuffizienz und schmalem QRS-Komplex ist die CCM momentan außerhalb von Studien zusammen mit der Barorezeptortherapie die einzige additive elektrische Therapieoption in Deutschland. Erstmalig erfolgte aktuell eine Berücksichtigung in den neuen Leitlinien der Herzinsuffizienz. Prognostische Daten zur Mortalität liegen als Fallserien vor, aktuell laufen diesbezüglich randomisierte Studien bzw. Register, die mittlerweile teilweise publiziert sind. Eine Zulassung durch die Food and Drug Administration wird in den nächsten Monaten erwartet.

Abstract

Cardiac contractility modulation (CCM) is a device-based electrical therapy for the additive treatment of chronic drug-refractory heart insufficiency. High-amplitude signals are applied during the absolute refractory period and have been shown to enhance the strength of left ventricular (LV) contraction and improve exercise tolerance and quality of life. The mechanisms of action appear to involve effects on myocardial gene expression and on normalization of key myocardial proteins. So far, more than 3500 CCM devices have been implanted worldwide. For patients with therapy refractory heart insufficiency and narrow QRS complex, CCM is together with baroreceptor activation the only additive electrical therapy which had been approved in Germany. For the first time CCM has been referenced in the current guidelines on cardiac insufficiency. Prognostic data with respect to mortality have been evaluated in case series. Ongoing randomized trials and registries will address these specific endpoints and have to a significant extent already been recently published. A Food and Drug Administration (FDA) approval is expected within the next few months.

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Affiliations

  1. I. Medizinische Klinik, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    J. Kuschyk, B. Rudic, M. Borggrefe & I. Akin

Authors
  1. J. Kuschyk
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  2. B. Rudic
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  3. M. Borggrefe
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  4. I. Akin
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Correspondence to J. Kuschyk.

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Interessenkonflikt

J. Kuschyk und M. Borggrefe: Beratertätigkeit, Vortragshonorare und Reisekostenübernahme von Impulse Dynamics und Boston Scientific. B. Rudic: Vortragshonorare und Reisekostenübernahme von Impulse Dynamics und Boston Scientific. I. Akin gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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G. Hasenfuß, Göttingen

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Kuschyk, J., Rudic, B., Borggrefe, M. et al. Kardiale Kontraktilitätsmodulation. Internist 59, 1021–1027 (2018). https://doi.org/10.1007/s00108-018-0493-3

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  • DOI: https://doi.org/10.1007/s00108-018-0493-3

Schlüsselwörter

  • Herzinsuffizienz
  • Schmaler QRS-Komplex
  • Belastungskapazität
  • Lebensqualität
  • Implantierbare Kardioverter-Defibrillatoren

Keywords

  • Heart failure
  • Narrow QRS
  • Exercise tolerance
  • Quality of life
  • Cardioverter defibrillators, implantable