Heart Rhythm
Volume 3, Issue 10 , Pages 1140-1147 , October 2006

Nonexcitatory, cardiac contractility modulation electrical impulses: Feasibility study for advanced heart failure in patients with normal QRS duration

  • Suresh B. Neelagaru, MD

      Affiliations

    • Lone Star Arrhythmia and Heart Failure Center, Amarillo, Texas
  • ,
  • Javier E. Sanchez, MD

      Affiliations

    • Texas Cardiac Arrhythmia, Austin, Texas
  • ,
  • Stanley K. Lau, MD

      Affiliations

    • Southern California Heart Centers, San Gabriel, California
  • ,
  • Steven M. Greenberg, MD

      Affiliations

    • St. Francis Hospital, Roslyn, New York
  • ,
  • Nirav Y. Raval, MD

      Affiliations

    • St. Joseph’s Hospital, Atlanta, Georgia
  • ,
  • Seth Worley, MD

      Affiliations

    • Lancaster General Hospital, Lancaster, Pennsylvania
  • ,
  • Jill Kalman, MD

      Affiliations

    • New York University School of Medicine, New York, New York
  • ,
  • Andrew D. Merliss, MD

      Affiliations

    • BryanLGH Medical Center, Lincoln, Nebraska
  • ,
  • Steven Krueger, MD

      Affiliations

    • BryanLGH Medical Center, Lincoln, Nebraska
  • ,
  • Mark Wood, MD

      Affiliations

    • Virginia Commonwealth University Medical Center, Richmond, Virginia
  • ,
  • Marc Wish, MD

      Affiliations

    • Arrhythmia Associates, Fairfax, Virginia
  • ,
  • Daniel Burkhoff, MD

      Affiliations

    • Cardiovascular Research Foundation, Orangeburg, New York
    • Columbia University, New York, New York
  • ,
  • Koonlawee Nademanee, MD

      Affiliations

    • Pacific Rim EP, Inglewood, California
    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Koonlawee Nademanee, Pacific Rim Electrophysiology Research Institute, 575 E. Hardy Street, Suite 201, Inglewood, California 90301.

Received 27 April 2006 ,Accepted 26 June 2006.

References 

  1. Auricchio A , Sommariva L , Salo RW , Scafuri A , Chiariello L . Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual chamber pacing with shortened AV delay . Pacing Clin Electrophysiol . 1993;16:2034–2043
  2. Auricchio A , Abraham WT . Cardiac resynchronization therapy: current state of the art: cost versus benefit . Circulation . 2004;109:300–307
  3. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure . N Engl J Med . 2002;346:1845–1853
  4. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure . N Engl J Med . 2004;350:2140–2150
  5. St. John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR, et al. Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure . Circulation . 2003;107:1985–1990
  6. Sandhu R , Bahler RC . Prevalence of QRS prolongation in a community hospital cohort of patients with heart failure and its relation to left ventricular systolic dysfunction . Am J Cardiol . 2004;93:244–246
  7. Shenkman HJ, Pampati V, Khandelwal AK, McKinnon J, Nori D, Kaatz S, et al. Congestive heart failure and QRS duration: establishing prognosis study . Chest . 2002;122:528–534
  8. Burkhoff D, Shemer I, Felzen B, Shimizu J, Mika Y, Dickstein M, et al. Electric currents applied during the refractory period can modulate cardiac contractility in vitro and in vivo . Heart Fail Rev . 2001;6:27–34
  9. Pappone C, Vicedomini G, Salvati A, Meloni C, Haddad W, Aviv R, et al. Electrical modulation of cardiac contractility: clinical aspects in congestive heart failure . Heart Fail Rev . 2001;6:55–60
  10. Pappone C, Rosanio S, Burkhoff D, Mika Y, Vicedomini G, Augello G, et al. Cardiac contractility modulation by electric currents applied during the refractory period in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy . Am J Cardiol . 2002;90:1307–1313
  11. Pappone C, Augello G, Rosanio S, Vicedomini G, Santinelli V, Romano M, et al. First human chronic experience with cardiac contractility modulation by nonexcitatory electrical currents for treating systolic heart failure: mid-term safety and efficacy results from a multicenter study . J Cardiovasc Electrophysiol . 2004;15:418–427
  12. Stix G, Borggrefe M, Wolpert C, Hindricks G, Kottkamp H, Bocker D, et al. Chronic electrical stimulation during the absolute refractory period of the myocardium improves severe heart failure . Eur Heart J . 2004;25:650–655
  13. Burkhoff D , Ben Haim SA . Nonexcitatory electrical signals for enhancing ventricular contractility: rationale and initial investigations of an experimental treatment for heart failure . Am J Physiol Heart Circ Physiol . 2005;288:H2550–H2556
  14. Brunckhorst CB , Shemer I , Mika Y , Ben Haim SA , Burkhoff D . Cardiac contractility modulation by non-excitatory currents: studies in isolated cardiac muscle . Eur J Heart Fail . 2006;8:7–15
  15. Lawo T, Borggrefe M, Butter C, Hindricks G, Schmidinger H, Mika Y, et al. Electrical signals applied during the absolute refractory period: an investigational treatment for advanced heart failure in patients with normal QRS duration . Am Coll Cardiol . 2005;46:2229–2236
  16. Wood EH , Heppner RL , Weidmann S . Inotropic effects of electric currents: 1 (Positive and negative effects of constant electric currents or current pulses applied during cardiac action potential) . Circ Res . 1969;24:409–445
  17. Wood EH , Heppner RL , Weidmann S . Inotropic effects of electric currents: 2 (Hypotheses: calcium movements, excitation-contraction coupling and inotropic effects) . Circ Res . 1969;24:409–445
  18. Antoni H , Jacob R , Kaufmann R . Mechanical response of the frog and mammalian myocardium to changes in the action potential duration by constant current pulses . Pflugers Arch . 1969;306:33–57
  19. Kaufmann RL , Antoni H , Hennekes R , Jacob R , Kohlhardt M , Lab MJ . Mechanical response of the mammalian myocardium to modifications of the action potential . Cardiovasc Res . 1971;1(Suppl):70
  20. Kerth WJ , Kelly JJ . Experience with paired pacing in experimental canine heart failure . Bull N Y Acad Med . 1965;41:646–651
  21. Goldsmith RL , Trufant JW , Mueller GM , Arwady MA , Burkhoff D . Optimizing exercise protocols for heart failure trials (abstr) . J Am Coll Cardiol . 2004;43:A169
  22. Rector TS , Kubo SH , Cohn JN . Validity of the Minnesota Living with Heart Failure questionnaire as a measure of therapeutic response to enalapril or placebo . Am J Cardiol . 1993;71:1106–1107
  23. Pappone C , Vicedomini G , Loricchio ML . First clinical experience demonstrating improvement of hemodynamic parameters in heart failure patients through the application of non-excitatory electrical signals (abstr) . J Am Col Cardiol . 2000;35(Suppl A):A-229
  24. Sabbah HN, Haddad W, Mika Y, Nass O, Aviv R, Sharov VG, et al. Cardiac contractility modulation with the impulse dynamics signal: studies in dogs with chronic heart failure . Heart Fail Rev . 2001;6:45–53
  25. Morita H, Suzuki G, Haddad W, Mika Y, Tanhehco EJ, Sharov VG, et al. Cardiac contractility modulation with nonexcitatory electric signals improves left ventricular function in dogs with chronic heart failure . J Card Fail . 2003;9:69–75
  26. Morita H, Suzuki G, Haddad W, Mika Y, Tanhehco EJ, Goldstein S, et al. Long-term effects of non-excitatory cardiac contractility modulation electric signals on the progression of heart failure in dogs . Eur J Heart Fail . 2004;6:145–150
  27. Mohri S, He KL, Dickstein M, Mika Y, Shimizu J, Shemer I, et al. Cardiac contractility modulation by electric currents applied during the refractory period . Am J Physiol Heart Circ Physiol . 2002;282:H1642–H1647
  28. Butter C , Wellnhofer E , Schlegl M , Winbeck G , Burkhoff D , Fleck E . Enhanced inotropic state by cardiac contractility modulation signals is not associated with changes in myocardial oxygen consumption (abstr) . Heart Rhythm . 2004;1:S278
  29. Mohri S, Shimizu J, Mika Y, Shemer I, Wang J, Ben-Haim S, et al. Electric currents applied during the refractory period enhance contractility and systolic calcium in the ferret heart . Am J Physiol Heart Circ Physiol . 2003;284:1119–1123
  30. Feldman AM , Weinberg EO , Ray PE , Lorell BH . Selective changes in cardiac gene expression during compensated hypertrophy and the transition to cardiac decompensation in rats with chronic aortic banding . Circ Res . 1993;73:184–192
  31. Colucci WS . Molecular and cellular mechanisms of myocardial failure . Am J Cardiol . 1997;80:15L–25L
  32. Mishra S , Gupta RC , Haddad W , et al.   Therapy with non-excitatory cardiac contractility modulation electrical signals partially restores MRNA expression of connexin 43 in left ventricular myocardium of dogs with heart failure [abstr] . J Card Fail . 2004;10:153
  33. Gupta RC , Mishra S , Rastogi S , et al.   Short-term therapy with non-excitatory modulation electric signals increases phosphorylation of phospholamban in left ventricular myocardium of dogs with chronic heart failure (abstr) . Eur Heart J . 2004;25:1116
  34. Gupta RC , Mishra S , Rastogi S , et al.   Non-excitatory cardiac contractility modulation electric signals normalize phosphorylation and expression of the sodium calcium exchanger in left ventricular myocardium of dogs with heart failure (abstr) . Eur Heart J . 2004;25:1116
  35. Rastogi S , Mishra S , Habib O , et al.   Therapy with non-excitatory cardiac contractility modulation electric signals reverses the maladaptive fetal gene program in LV myocardium of dogs with heart failure [abstr] . Circulation . 2003;108:IV-444
  36. Mishra S , Gupta RC , Rastogi S , Haddad W , Mika Y , Sabbah HN . Short-term therapy with nonexcitatory cardiac contractility modulation electric signals increases phosphorylation of phospholamban in left ventricular myocardium of dogs with chronic heart failure (abstr) . Circulation . 2004;110:III-604
  37. Gupta RC , Mishra S , Sharad R , et al.   Non-excitatory cardiac contractility modulation electric signals normalize phosphorylation and expression of the sodium calcium exchanger in left ventricular myocardium of dogs with heart failure . (abstr) J Am Coll Cardiol . 2005;45:151A

 This study was supported by a research grant from IMPULSE Dynamics, Orangeburg, New York, USA, the manufacturer of the OPTIMIZER system. Dr. Burkhoff is an employee of IMPULSE Dynamics.

PII: S1547-5271(06)01727-9

doi: 10.1016/j.hrthm.2006.06.031

Heart Rhythm
Volume 3, Issue 10 , Pages 1140-1147 , October 2006