Key result
Cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation did not increase ventricular arrhythmias over 12 months (median PVCs/day 330 at baseline vs 194 at 12 months, p=0.169).
Why the study?
The study evaluated the dynamics of cardiac arrhythmias during cardiac contractility modulation in patients with chronic heart failure and various forms of atrial fibrillation using daily ECG monitoring.
Does cardiac contractility modulation improve cardiac arrhythmias and reverse remodeling in patients with chronic heart failure and atrial fibrillation?
Observational (n=100)
No
Does cardiac contractility modulation improve cardiac arrhythmias and reverse remodeling in patients with chronic heart failure and atrial fibrillation?
Absolute Event Rate: 194% vs 330%
p-value: p=0.169
Cardiac contractility modulation in patients with heart failure and atrial fibrillation is safe, does not induce ventricular arrhythmias, and improves left ventricular ejection fraction and functional class over 12 months.
May support arrhythmia safety of cardiac contractility modulation in HF with AF; hypothesis-generating, requires RCTs before practice change.
AIM: To evaluate the dynamics of cardiac arrhythmias on the background of cardiac contractility modulation (MCC) in patients with chronic heart failure (CHF) and various forms of atrial fibrillation (AF) on the basis of daily electrocardiogram (ECG) monitoring. MATERIALS AND METHODS: In 100 patients with CHF and AF, the following studies were performed before implantation of the MCC device and after 12 months of follow-up: 12-channel ECG with an estimate of the width of the QRS complex, transthoracic echocardiography (EchoCG), and Holter ECG monitoring. All patients received long-term optimal drug therapy for CHF before surgery. RESULTS: The results obtained indicate that there is no effect of MCC on the development and progression of ventricular arrhythmias in patients with CHF and AF during the year of follow-up, both extrasystole and tachyarrhythmias, regardless of the etiology and LVEF (less than 35% or more than 35%), and a decrease in the frequency of AF paroxysms in patients with CHF during treatment. These results are due to the reverse remodeling of the LV myocardium under the influence of the MCC device. CONCLUSION: The use of MСС in patients with CHF and AF is a safe method of therapy that does not induce cardiac arrhythmias, including ventricular extrasystole. Large-scale comparative studies are required to evaluate these results.
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Сафиуллина et al. (2021) conducted an observational in Chronic heart failure and atrial fibrillation (n=100). Cardiac contractility modulation (Optimizer Smart) vs. Baseline (pre-implantation) was evaluated on Total premature ventricular contractions (PVCs) per day (p=0.169). Cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation did not increase ventricular arrhythmias over 12 months (median PVCs/day 330 at baseline vs 194 at 12 months, p=0.169).
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