Cardiac Contractility Modulation in Heart Failure: Mechanisms and Clinical Evidence

Purpose of review Device-based therapy utilizing cardiac contractility modulation (CCM (TM)) was approved by the FDA in March 2019 for patients with moderately to severely symptomatic heart failure with reduced ejection fraction between 25 and 45% on optimal guideline-directed medical therapy in normal sinus rhythm and not a candidate for cardiac resynchronization therapy. This review explores the mechanism of action behind CCM, the most recent clinical trials, and the expansion of therapy to additional patient populations. Recent findings The most recent trial on CCM explored a two-lead system, which was as equally efficacious as three-lead model. Importantly, CCM was shown to be effective in patients with atrial fibrillation (AF), who made up 15% of the population studied. Furthermore, emerging data from the European Registry suggests improvement in mortality with the use of CCM. Summary New developments of a two-lead system have allowed for expansion into a broader array of patient populations, including those with AF, while maintaining the safety and efficacy of this therapy.