Cardiac contractility modulation in a patient with refractory systolic heart failure following orthotopic heart transplant

Cardiac contractility modulation is a device-based therapeutic option for patients with advanced heart failure with reduced ejection fraction and a left ventricular ejection fraction between 25% and 45%, who do not benefit from resynchronization therapy and are still symptomatic despite optimal medical therapy. By generating nonexcitatory electrical signals during the myocardial absolute refractory period, cardiac contractility modulation therapy acts directly on cardiac contractility. These high-voltage biphasic electrical impulses do not cause myocardial contraction but appear to have an effect on cellular pathways that regulate calcium cycling, improving myocardial contractility. Management of chronic refractory heart failure with reduced ejection fraction in heart transplant patients is challenging. Cardiac contractility modulation may represent a new option for the heart transplant care team involved in the treatment of this specific cohort of patients