I. Medical Department, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim D-68167, Germany
I. Medical Department, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim D-68167, Germany.
Europace. 2014 Aug;16(8):1205-9. doi: 10.1093/europace/euu050. Epub 2014 Apr 4.
Cardiac contractility modulation (CCM) is an electrical therapy for heart failure (HF) with reduced ejection fraction. Sinus rhythm is deemed necessary for effective treatment because the current CCM signal delivery algorithm requires sequential sensing of a p wave, followed by depolarizations at each ventricular lead. In case of atrial fibrillation (AF) CCM is inhibited. This study demonstrates the feasibility of CCM therapy in patients with permanent AF by circumventing the requirement for sensing of a natural p wave.
Five CCM patients with AF received a pacemaker or implantable cardioverter/defibrillator (ICD) upgrade to cardiac resynchronization therapy (CRT) with low atrial sensitivity, which resulted in compulsory atrial stimulation followed by biventricular pacing. The CCM system recognized the atrial stimuli as p waves, which led to CCM signal delivery. Three patients developed permanent AF after a mean follow-up of 40 months of CCM therapy. Two patients had permanent AF at the time of CCM device implantation. All pacemaker or ICD devices were successfully upgraded to CRT. Cardiac resynchronization therapy stimulation rates of ≥96% and CCM stimulation rates between 60% and 95% were achieved. Clinical condition of the patients improved (mean NYHA class -0.7, left ventricular ejection fraction +2%, Minnesota living with HF questionnaire -15.6 points).
CCM signal delivery is feasible in HF patients with permanent AF by sequential atrial-ventricular pacing, so that the atrial pacing spike is interpreted as a p wave by the CCM signal delivery algorithm. This experimental approach can be considered in individual cases. A new CCM algorithm, which does not require an atrial electrode, is desirable.
心脏收缩力调节（CCM）是一种用于射血分数降低的心力衰竭（HF）的电治疗方法。窦性节律被认为是有效治疗的必要条件，因为当前的 CCM 信号传递算法需要依次感测 p 波，然后在每个心室导联进行去极化。在心房颤动（AF）的情况下，CCM 被抑制。本研究通过绕过感测自然 p 波的要求，证明了 CCM 治疗在永久性 AF 患者中的可行性。
5 例 AF 患者接受了起搏器或植入式心脏复律除颤器（ICD）升级为具有低心房感知灵敏度的心脏再同步治疗（CRT），这导致强制心房刺激，随后进行双心室起搏。CCM 系统将心房刺激识别为 p 波，从而导致 CCM 信号传递。在接受 CCM 治疗 40 个月的平均随访后，有 3 例患者发展为永久性 AF。2 例患者在 CCM 设备植入时即患有永久性 AF。所有起搏器或 ICD 设备均成功升级为 CRT。达到了 CRT 刺激率≥96%和 CCM 刺激率在 60%至 95%之间。患者的临床状况得到改善（平均 NYHA 分级-0.7，左心室射血分数+2%，明尼苏达州心力衰竭生活质量问卷-15.6 分）。
通过顺序的房室起搏，CCM 信号传递在永久性 AF 的 HF 患者中是可行的，使得 CCM 信号传递算法将心房起搏尖峰解释为 p 波。这种实验方法可以在个别情况下考虑。需要一种不依赖心房电极的新型 CCM 算法。
