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Background. Cardiac contractility modulation (CCM) is a device therapy for systolic heart failure (HF) in patients with narrow QRS. We aimed to perform an updated meta-analysis of the randomized clinical trials (RCTs) to assess the efficacy and safety of CCM therapy. Methods. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) between January 2001 and June 2018. Outcomes of interest were peak oxygen consumption (peak VO2), 6-Minute Walk Distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), HF hospitalizations, cardiac arrhythmias, pacemaker/ICD malfunctioning, all-cause hospitalizations, and mortality. Data were expressed as standardized mean difference (SMD) or odds ratio (OR). Results. Four RCTs including 801 patients (CCM n = 394) were available for analysis. The mean age was 59.63 ± 0.84 years, mean ejection fraction was 29.14 ± 1.22%, and mean QRS duration was 106.23 ± 1.65 msec. Mean follow-up duration was six months. CCM was associated with improved MLWHFQ (SMD -0.69, p = 0.0008). There were no differences in HF hospitalizations (OR 0.76, p = 0.12), 6MWD (SMD 0.67, p = 0.10), arrhythmias (OR 1.40, p = 0.14), pacemaker/ICD malfunction/sensing defect (OR 2.23, p = 0.06), all-cause hospitalizations (OR 0.73, p = 0.33), or all-cause mortality (OR 1.04, p = 0.92) between the CCM and non-CCM groups. Conclusions. Short-term treatment with CCM may improve MLFHQ without significant difference in 6MWD, arrhythmic events, HF hospitalizations, all-cause hospitalizations, and all-cause mortality. There is a trend towards increased pacemaker/ICD device malfunction. Larger RCTs might be needed to determine if the CCM therapy will be beneficial with longer follow-up. [ABSTRACT FROM AUTHOR]

Background: Cardiac contractility modulation (CCM) is a promising device therapy for heart failure (HF) patients with reduced ejection fraction and narrow QRS. However, outcomes have varied among different studies. Methods: A systematic review and meta-analysis of published randomized trials between January 2001 and June 2018 was performed. Outcomes of interest were: peak oxygen consumption (peak VO2), quality of life (QOL) measured by Minnesota Living with Heart Failure Questionnaire (MLHFQ), 6 Minute Walk Distance (6MWD), worsening HF hospitalizations, adverse events, and all-cause mortality. Data was expressed as mean difference or random effects DerSimonian-Laird risk ratios (RR) with 95% confidence interval (CI). Results: Four randomized studies enrolling a total of 801 patients, including 394 patients with CCM, were identified. Baseline demographics were: mean age 59.63 ± 0.84 years, 75.3% males, 63.7% ischemic cardiomyopathy, mean ejection fraction 29.14 ± 1.22%, and mean QRS duration 106.23 ± 1.65 msec. CCM was associated with improved peak VO2 (mean difference 0.71, 95% CI 0.20 to 1.21 mL/kg/min, p = 0.006), 6MWD (mean difference 18.34, 95% CI 6.01 to 30.68 meters, p = 0.004) and QOL measured by MLHFQ (mean difference –7.86, 95% CI –10.77 to –4.95, p < 0.00001). There was no difference in HF hospitalizations (RR 0.84, 95% CI 0.66 to 1.06, p = 0.14), adverse events (RR 1.03, 95% CI 0.97 to 1.10, p = 0.33), or mortality (RR 0.79, 95% CI 0.43 to 1.46, p = 0.46) between the CCM and non-CCM groups. Conclusions: In patients with severe heart failure and narrow QRS, CCM improves peak VO2, 6MWD and QOL when compared to optimal medical management alone, but with no mortality benefit. [ABSTRACT FROM AUTHOR]