Cardiac Contractility Modulation Therapy in a Transplant Candidate Patient with Advanced Heart Failure to Improve Cardiac Function and Restore Sinus Rhythm

Cardiac Contractility Modulation (CCM) is an electrical therapy based on an implantable device. This device is approved for patients with heart failure with reduced ejection fraction (HFrEF). Randomized clinical trials and thousands of described cases and studies have shown how CCM can improve exercise tolerance, quality of life, re-hospitalization for HF, and cardiac function by reverse left ventricular modelling. In this case report, we describe a patient candidate for a cardiac transplant based on dilated cardiomyopathy with severe LV dysfunction and narrow QRS. The patient had frequent heart failure-related hospitalizations, despite the optimal medical therapy. The strategy was to adopt the Cardiac Contractility Modulation (CCM) therapy while waiting for a cardiac transplant. During a consultation on all prospective therapy options, the patient refused the LVAD therapy, and was more confident in adopting a less invasive device therapy like CCM. This strategy had a very fast and beneficial impact on the patient’s health; the CCM improved heart failure symptoms, hemodynamics flow and cardiac functionality. Moreover, after a relatively short time, the patient went from persistent AF to Sinus Rhythm, although he started with a severe bi-atrial dilatation. These parameters were stable during an extended follow-up of 18 months.