Role of Cardiac Contractility Modulation in Heart Failure with a Higher Ejection Fraction.

Cardiac Contractility Modulation (also known as CCM) is a novel device therapy that delivers non-excitatory electric stimulation to cardiac myocytes during the absolute refractory period and has been shown to improve functional status and clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). CCM therapy is currently recommended for a subset of patients with advanced HFrEF that are not candidates for cardiac resynchronisation therapy. A growing body of evidence demonstrates the benefit of CCM therapy in HFrEF patients with ejection fraction at the upper end of the spectrum and in patients with HF with mildly reduced ejection fraction (HFmrEF). Experimental studies have also observed reversal of pathological biomolecular intra-cellular changes with CCM therapy in HF with preserved ejection fraction (HFpEF), indicating the potential for clinically meaningful benefit of CCM therapy in these patients. In this review, we sought to discuss the basis of CCM therapy and its potential for management of patients with HF with higher ejection fractions.