Modulation of Heart Contractility

Modulação da Contratilidade Cardíaca

  • Tiago Luiz Silvestrini
  • Rafael de March Ronsoni
  • Celso Salgado
Keywords: Heart failure, Artificial pacemaker, Electric stimulation therapy


Patients with heart failure (HF) are being benefited by electric therapy through conventional pacemakers when associated to bradycardia and cardiac resynchronization therapy or with low ejection fraction and presence of QRS longer than 150 ms, mainly in the presence of left branch block. Other groups of patients with HF present limitations regarding electrotherapy. However, an old concept has gained space in the treatment of patients who are outside the national and international guidelines for electrotherapy in HF: the modulation of heart contractility. This article has the purpose of presenting a review of already
produced scientific evidence regarding this new modality for HF


Download data is not yet available.


Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmic Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51(21):e1-62.

Wilcox JE, Fonarow GC, Zhang Y, Albert NM, Curtis AB, Yancy CW et al. Clinical effectiveness of cardiac resynchronization and implantable cardioverter-defibrillator therapy in men and women with heart failure: findings from IMPROVE HF. Circ Heart Fail. 2014;7(1):146-53.

Abi-Samar F, Gutterman D. Cardiac contractility modulation: a novel approach for the treatment of heart

failure. Heart Fail Rev. 2016;21(6):645-60.

Braunwald E, Zipes DP, Libby P, Bonow RO. Braunwald’s hearth disease: a text book of cardiovascular medicine. 7a ed. 2015.

Dibb KM, Graham HK, Venetucci LA, Eisner DA, Trafford AW. Analysis of cellular calcium fluxes in cardiac muscle to understand calcium homeostasis in the heart. Cell Calcium. 2007;42(4-5):503-512.

Bears DM. Cardiac excitation-contraction coupling. Nature. 2002;415(6868):198-205.

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(1):27-34.

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(1):69-75.

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(2):145-150

Butter C, Rastogi S, Minden HH, Meyhofer J, Burkhoff D, Sabbah HN. Cardiac contractility modulation electrical signals improve myocardial gene expression in patients with heart failure. J Am Coll Cardiol. 2008;51(18):1784-9.

Imai M, Rastogi S, Gupta RC, Mishra S, Sharov VG, Stanley WC, et al. Therapy with cardiac contractility modulation electrical signals improves left ventricular function and remodeling in dogs with chronic heart failure. J Am Coll Cardiol. 2007;49(21):2120-8.

Lyon AR, Samara MA, Feldman DS. Cardiac contractility modulation therapy in advanced systolic heart failure. Nat Rev Cardiol. 2013;10(10):584-98.

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(8):650-5.

Borggrefe MM, Lawo T, Butter C, Schmidinger H, Lunati M, Pieske B, et al. Randomized, double blind study of nonexcitatory, cardiac contractility modulation electrical impulses for symptomatic heart failure. Eur Heart J. 2008;29(8):1019-28.

Kadish A, Nademanee K, Volosin K, Krueger S, Neelagaru S, Raval N, et al. A randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure. Am Heart J. 2011;161(2):329-37.

Kwong JS, Sanderson JE, Yu CM. Cardiac contractility modulation for heart failure: a meta-analysis of randomized controlled trials. Pacing Clin electrophysio. l. 2012;35(9):1111-8.

Giallauria F, Vigorito C, Piepoli MF, Stewart Coats AJ. Effects of cardiac contractility modulation by non-excitatory electrical stimulation on exercise capacity and quality of life: an individual patient’s data meta-analysis of randomized controlled trials. Int J Cardiol. 2014;175(2):352-7.

Schau T, Seifert M, Meyhofer J, Neuss M, Butter C. Long-term outcome of cardiac contractility modulation in patients with severe congestive heart failure. Europace. 2011;13(10):1436-44.

Kuschyk J, Roeger S, Schneider R, Streitner F, Stach K, Rudic B, et al. Efficacy and survival in patients with cardiac contractility modulation: long-term single center experience in 81 patients. Int J Cardiol. 2015;183(15):76-81.

Liu M, Fang F, Luo XX, Shlomo BH, Burkhoff D, Chan JY, et al. Improvement of long-term survival by cardiac contractility modulation in heart failure patients: a case-control study. Int J Cardiol. 2016;206(1):122-6.

Kloppe A, Lawo T, Mijic D, Schiedat F, Muegge A, Lemke B. Long-term survival with cardiac contractility modulation in patients with NYHA II or III. Int J Cardiol. 2016; 209 (15):291-295.

Ponikowiski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(27):2129-2200.

How to Cite
Silvestrini, T. L., Ronsoni, R. de M., & Salgado, C. (2019). Modulation of Heart Contractility. JOURNAL OF CARDIAC ARRHYTHMIAS, 32(2), 108-117. Retrieved from
Cardiac Pacing