Normalization of ventricular function after cardiac contractility modulation in noncompaction cardiomyopathy heterozygous positive for a pathologic TTN gene variant

Cardiac contractility modulation (CCM) may be used as an adjunct for the treatment of medically refractory class III chronic systolic congestive heart failure (CHF) with ejection fraction (EF) 25%–45% not indicated for biventricular pacing.1–3 CCM treats CHF through effecting improvement in myocardial cellular calcium handling and with reversal of adverse gene dysregulations.4,5 Enhanced phosphorylation of the giant myocardial protein titin also occurs with CCM, which can improve myocardial relaxation.