Cardiac Contractility Modulation Device and Subcutaneous Implantable Cardioverter Defibrillator Combination: A New Hope for Heart Failure Patients with Low Ejection Fraction and Narrow QRS Complex

Background: Heart failure (HF) is a common cardiovascular disease with high rates of morbidity and mortality despite advances in medical and device-related management. Cardiac Contractility Modulation (CCM) is a promising therapy in HF patients with narrow QRS complex and CCM devices are approved and available for clinical use in Europe. On the other hand, there has recently been an increased interest in subcutaneous implantable cardioverter defibrillators (S-ICD) in HF patients with low ejection fraction. S-ICDs obviate the vascular and lead complications associated with conventional ICDs. There are limited data about the combination of CCM and S-ICD in management of HF patients. Methods: We reviewed literature about current use of CCM and S-ICD as well as data on their use in combination. We are also reporting our first case with this combination. Results: The combination of the two devices is feasible, seems to be safe, and is without significant interaction between the two systems. Conclusion: CCM and S-ICD combination in patients with HF, functional class II-IV, low ejection fraction, and narrow QRS is an attractive approach as it avoids numerous leads inside the body. However, more studies are needed to prove that this approach is effective and has good clinical outcome.