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Clinical experience of using cardiac contractility modulation devices in patients with heart failure:the true or wrong way to success?

Session Poster Session 2

Speaker Victoria Galenko

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Treatment, Other
  • Session type : Poster Session

Authors : M Trukshina (St.Petersburg,RU), E Lyasnikova (St.Petersburg,RU), V Galenko (St.Petersburg,RU), T Lelyavina (St.Petersburg,RU), M Sitnikova (St.Petersburg,RU), I Kim (St.Petersburg,RU), Z Abakarov (St.Petersburg,RU), M Abramov (St.Petersburg,RU), E Mikhaylov (St.Petersburg,RU), E Zubarev (St.Petersburg,RU), M Vander (St.Petersburg,RU), K Simonova (St.Petersburg,RU), D Lebedev (St.Petersburg,RU), O Stovpyuk (St.Petersburg,RU), E Shlyakhto (St.Petersburg,RU)

M Trukshina1 , E Lyasnikova1 , V Galenko1 , T Lelyavina1 , M Sitnikova1 , I Kim1 , Z Abakarov1 , M Abramov1 , E Mikhaylov1 , E Zubarev1 , M Vander1 , K Simonova1 , D Lebedev1 , O Stovpyuk1 , E Shlyakhto1 , 1Almazov National Medical Research Centre, Heart Failure - St.Petersburg - Russian Federation ,


Introduction: Cardiac Contractility Modulation (CCM) is an original approach in new device therapy to improve contractility in patients with heart failure with reduced ejection fraction (HFrEF), on OMT, with sinus rhythm (SR) and narrow QRS complex. Purpose: To assess the dynamics of the CHF, adverse events rate, structural and functional parameters of the heart in patients with implanted CCM devices during follow-up period. Methods: From 20 Oct 2016 till 12 Sep 2017 CCM devices n=55 (50 - Optimizer IVs, 5 - Optimizer Smart) were implanted to the patients with CHF I-IV fc NYHA, > 18 y.o. (55,0 ±10,6), SR, QRS<120 ms. 46 male,9 female, 36 - CAD, DCM – 19, fc NYHA I/II/III/IV- 1/37/12/5; 10 patients were with ICD. Patients were followed-up by CHF cardiologists every 3 months in outpatient HF clinic with physical examination, device programming, assessment of the life quality, cardiopulmonary exercise test, ECG, Holter Monitoring (HM), Echocardiography(Echo) and NT-proBNP level. Results: Patients had good compliance and tolerance of CCM stimulation. No hospitalizations due to CHF or outpatient decompensation occurred among 43 patients who passed 6 month follow-up control visit. 11 of them felt clinical improvement, 4 - worsening, 28 –without any changes; fc NYHA I/ II/ III/IV- 3/33/7/0. The positive trend in Echo and NT-proBNP data was observed: LVEF increased 26.0 ± 5.4 (15-38%) vs 30.5.0 ± 7.95% (17-41), p = 0,08; LVEDV and LVESV decreased accordingly: 244.0 ± 59.8 ml (145-360) vs 233.5 ± 59.6 ml (116-380), 185.0 ± 50.9 ml (85-273) vs 163.0 ± 51.0 ml (70-290). NT-proBNP level - 1049.5pg/ml (241-20 198) vs 771pg/ml (42-3 962). ECG and HM data did not reveal any PQ, QRS, QT interval prolongation and significant rhythm and conduction disorders. Within 6 months, the following adverse events occured: 2 patients were hospitalized with unstable angina (conservative treatment), 2 died suddenly. In 12 patients stimulation of the CCM pocket was due to dislocation of the ventricular leads, in 14 patients 1 lead was disconnected because of technical problems, replacement of 2 leads was planned for 3 patients, in 1 patient CCM was deimplanted in early postoperative period time due to the device pocket infection. Conclusions: First clinical experience in 6-month follow-up of patients with CCM devices showed the stability of clinical status, decrease in CHF fc, good patients tolerance of stimulation, absense of arrhythmogenic effects, in some patients, mostly with DCM, tendency to improve cardiac remodeling. Ventricular lead insulation failure complications and pocket device stimulation which required switching off one of the ventricle leads present the most common negative aspects of a new method and may diminish the potential treatment effect. Long-term follow-up will help to identify the subgroup of patients to get the true way and maximum benefit.

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