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Verbesserung der linksventrikulären Kontraktilität durch Stimulation in der absoluten Refraktärperiode –

Cardiac Contractility Modulation (CCM)

Improving left ventricular contractility by stimulation during the absolute refractory period – Cardiac contractility modulation (CCM)

Herzschrittmachertherapie + Elektrophysiologie volume 19, pages 69–76 (2008)Cite this article

Abstract

Cardiac contractility modulation (CCM) is a treatment option for patients with systolic ventricular dysfunction, independent of QRS duration, moderate to severe systolic heart failure and symptoms despite optimal medical therapy. In contrast to cardiac resynchronization therapy (CRT) which has been an established therapy in patients with wide QRS and ventricular asynchrony, CCM can enhance cardiac contractility in patients independent of QRS duration. Whereas inotropic drugs increase oxygen demand, CCM works without additional myocardial oxygen need and without reference to asynchrony. Non-excitatory signals applied during the absolute refractory period have been shown to enhance the strength of left ventricular contraction in animals and humans with heart failure probably due to normalization of myocardial gene expression. Several multicenter studies have demonstrated safety and efficacy of CCM in patients with medically refractory heart failure. We describe the specific technical aspects and conditions in clinical application of CCM.

Zusammenfassung

Die Cardiac Contractility Modulation (CCM) ist eine neue Therapie für Patienten mit einer schweren therapierefraktären systolischen Herzinsuffizienz, unabhängig von der Breite des QRS-Komplexes unter optimaler medikamentöser Behandlung. Anders als bei der kardialen Resynchronisation (CRT), die sich bei der Behandlung der schweren Herzinsuffizienz mit QRS-Verbreiterung und ventrikulärer Asynchronie etabliert hat, kann CCM die myokardiale Kontraktilität steigern, ohne dass eine Steigerung des myokardialen Sauerstoffverbrauchs resultiert. Dies geschieht durch die Abgabe von elektrischen Impulsen während der absoluten Refraktärperiode des Myokards, ohne dass es zur Auslösung eines Aktionspotenzials kommt. Neben tierexperimentellen Studien gelang der Nachweis für einen sicheren und anhaltenden Therapieeffekt in multizentrischen Studien an herzinsuffizienten Patienten. Dabei konnten sowohl invasiv gemessene Parameter wie die dP/dt als auch die linksventrikuläre Funktion, die 6-Minuten-Gehstrecke und die maximale Sauerstoffaufnahme gesteigert werden. Ursächlich ist u. a. eine Normalisierung der pathologischen Veränderung der myokardialen Genexpression. Wir beschreiben die spezifischen Voraussetzungen und besonderen technischen Aspekte der CCM in der klinischen Anwendung.

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Affiliations

  1. Heart Center Brandenburg in Bernau/Berlin, Dept. of Cardiology, Ladeburger Straße 17, 16321, Bernau, Germany

    Martin Seifert, Jürgen Meyhöfer & Christian Butter

  2. Impulse Dynamics, Chollerstraße 3, 6300, Zug, Switzerland

    Jana Hoffmann

Authors
  1. Martin Seifert
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  2. Jana Hoffmann
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  3. Jürgen Meyhöfer
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  4. Christian Butter
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Correspondence to Martin Seifert.

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Seifert, M., Hoffmann, J., Meyhöfer, J. et al. Verbesserung der linksventrikulären Kontraktilität durch Stimulation in der absoluten Refraktärperiode –. Herzschr. Elektrophys. 19, 69–76 (2008). https://doi.org/10.1007/s00399-008-0609-x

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  • DOI: https://doi.org/10.1007/s00399-008-0609-x

Key words

  • cardiac contractility modulation-CCM
  • congestive heart failure and narrow QRS complex
  • pacing during refractory period
  • device therapy for heart failure

Schlüsselwörter

  • Kardiale Kontraktilitätssteigerung durch Stimulation
  • Gerätetherapie für Herzinsuffizienz
  • schmaler QRS-Komplex