title: Heart Failure With Reduced Ejection Fraction And A Narrow QRS Complex: Combination Of A Subcutaneous Defibrillator With Cardiac Contractility Modulation.
abstract: Cardiac contractility modulation (CCM) is a relatively new electrical therapy for heart failure patients with reduced ejection fraction. The majority of patients eligible for CCM will also need an implantable cardioverter-defibrillator (ICD). To-date, three pacing electrodes are mandatory for CCM therapy because the current CCM signal delivery algorithm requires sequential intracardiac sensing of a p-wave, followed by appropriately timed ventricular activation by the two ventricular septal leads. As there is no device combining CCM with ICD functions, most CCM patients will need multiple intracardiac electrodes, which increase the cumulative risk for complications such as systemic infections, thrombosis of central venous lines, insulation failures or lead fractures. The long-term complications associated with trans-venous ICD leads have led to the development of a totally subcutaneous implantable cardioverter-defibrillator (S-ICD). In this essay the two technologies CCM and S-ICD are reviewed. Additionally, we present their successful combination on the basis of a case report on the first patient receiving both devices.
authors.affiliation: Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Röger
authors.affiliation: Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kuschyk
keywords: Cardiac Contractility Modulation; Subcutaneous Implantable Cardioverter-Defibrillator