Long-term prognosis in patients with heart failure with reduced left ventricular ejection fraction, atrial fibrillation and implanted cardiac contractility modulation devices

Aim. To assess the effect of cardiac contractility modulation (CCM) in patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) on 5-year survival.

Material and methods. Two hundred patients with HFrEF and AF were included. Patients were consecutively included in two following groups: group 1 — patients with heart failure (HF) receiving optimal therapy in combination with implanted CCM devices (n=100); group 2 — comparison group — patients with HF receiving only optimal therapy (n=100). The mean follow-up period was 40,5±20,4 months. Cardiovascular death (CVD) was considered as the primary endpoint, and all-cause death was taken as the secondary endpoint.

Results. In the CCM group, a total of 24 deaths (24%) were registered during longterm follow-up, while in the optimal therapy group — 46 (46%). Primary endpoint rate (CVD after 5-year follow-up) was significantly higher in the optimal therapy group compared to CCM group and amounted to 38% and 19%, respectively (logrank test <0,003). In the CCM group, the secondary endpoint (all-cause death) was achieved in 26% (n=26), in the optimal therapy group — in 44%. Logrank showed significant survival differences (p=0,008). In cardiovascular mortality structure, two main causes should be highlighted — sudden cardiac death (SCD) and death due to decompensated HF. In the CCM group, SCD as a cause of CVD (n=6, 23%) was significantly less than in the optimal therapy group (n=16, 36%), p=0,039, while mortality for decompensated HF did not reach a significant difference (CCM: n=8, 30%, optimal therapy: n=17, 39%, p=0,085). CCM therapy has a significant effect on reducing the risk of both all-cause (relative risk=0,591, 95% confidence interval: 0,397-0,879, p=0,009) and cardiovascular death (relative risk=0,474, 95% confidence interval: 0,290-0,771, p=0,003) in long-term follow-up.

Conclusion. CCM significantly improves the long-term 5-year prognosis in patients with HF and AF.

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