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Anaesthesia and cardiac contractility modulation

Published online by Cambridge University Press:  01 October 2007

G. Huschak ,
H. Schmidt-Runke  and
H. Rüffert
G. Huschak*
Affiliation:
University Hospital of Leipzig, Department of Anaesthesiology and Intensive Care Therapy, Leipzig, Germany
H. Schmidt-Runke
Affiliation:
University Hospital of Leipzig, Department of Anaesthesiology and Intensive Care Therapy, Leipzig, Germany
H. Rüffert
Affiliation:
University Hospital of Leipzig, Department of Anaesthesiology and Intensive Care Therapy, Leipzig, Germany
*
Correspondence to: Gerald Huschak, Klinik für Anaesthesiologie und Intensivtherapie Universität Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany. E-mail:gerald.huschak@gmx.de; Tel: +49 (0)341 97 17700; Fax: +49 (0)341 97 17709
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Summary

Chronic heart failure is known to be an important risk factor for adverse perioperative outcome in patients undergoing non-cardiac surgery. A promising new form of electric therapy is currently being used in a phase III trial in patients with severe chronic heart failure (cardiac contractility modulation). Cardiac contractility modulation is a non-pharmacological approach to improve Ca2+ effect on cardiac myofilaments using electric currents. The cardiac contractility modulation system used at present (OPTIMIZER™ III, Impulse Dynamics, Orangeburg, NY, USA) consists of a subcutaneously implanted pulse generator and three electrodes. As far as we know, cardiac contractility modulation therapy is a safe and feasible way of improving the systolic function of the heart in congestive heart failure patients. No pro-arrhythmic effects of this new therapy have been reported. The technique shows promise as an additive treatment for severe chronic heart failure. The perioperative and intraoperative management of patients should follow current cardiac pacemaker/implantable cardioverter defibrillator guidelines.

Keywords

HEART FAILURE, CONGESTIVEMYOCARDIAL CONTRACTION, cardiac contractility modulationPACEMAKERS ARTIFICIAL
Type
Review
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 819 - 825
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Crouch, MA. Chronic heart failure: developments and perspectives. Consult Pharm 2005; 20: 751–765.CrossRefGoogle Scholar
2.Swedberg, K, Cleland, JDargie, H et al. . Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 1115–1140.CrossRefGoogle ScholarPubMed
3.Fleisher, LA, Eagle, KA. Clinical practice. Lowering cardiac risk in noncardiac surgery. N Engl J Med 2001; 345: 1677–1682.CrossRefGoogle ScholarPubMed
4.Movsesian, MA, Karimi, M, Green, K, Jones, LR. Ca2+-transporting ATPase, phospholamban, and calsequestrin levels in nonfailing and failing human myocardium. Circulation 1994; 90: 653–657.CrossRefGoogle ScholarPubMed
5.Flesch, M, Schwinger, RH, Schnabel, P et al. . Sarcoplasmic reticulum Ca2+ATPase and phospholamban mRNA and protein levels in endstage heart failure due to ischemic or dilated cardiomyopathy. J Mol Med 1996; 74: 321–332.CrossRefGoogle ScholarPubMed
6.Arai, M, Alpert, NR, MacLennan, DH, Barton, P, Periasamy, M. Alterations in sarcoplasmic reticulum gene expression in human heart failure. A possible mechanism for alterations in systolic and diastolic properties of the failing myocardium. Circ Res 1993; 72: 463–469.CrossRefGoogle ScholarPubMed
7.Alpert, NR, Periasamy, M, Arai, M et al. . The regulation of calcium cycling in stressed hearts. Basic Res Cardiol 1992; 87 (Suppl 2): 71–80.Google ScholarPubMed
8.Studer, R, Reinecke, H, Bilger, J et al. . Gene expression of the cardiac Na+–Ca2+ exchanger in endstage human heart failure. Circ Res 1994; 75: 443–453.CrossRefGoogle ScholarPubMed
9.Lehnart, SE, Schillinger, W, Pieske, B et al. . Sarcoplasmic reticulum proteins in heart failure. Ann N Y Acad Sci 1998; 853: 220–230.CrossRefGoogle ScholarPubMed
10.Hasenfuss, G, Schillinger, W, Lehnart, SE et al. . Relationship between Na+–Ca2+-exchanger protein levels and diastolic function of failing human myocardium. Circulation 1999; 99: 641–648.CrossRefGoogle ScholarPubMed
11.Isenberg, G. How can overexpression of Na+, Ca2+-exchanger compensate the negative inotropic effects of downregulated SERCA? Cardiovasc Res 2001; 49: 1–6.CrossRefGoogle Scholar
12.Augello, G, Santinelli, V, Vicedomini, G et al. . Cardiac contractility modulation by non-excitatory electrical currents. The new frontier for electrical therapy of heart failure. Ital Heart J 2004; 5 (Suppl 6): 68S–75S.Google ScholarPubMed
13.Nieminen, MS, Bohm, M, Cowie, MR et al. . Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 384–416.Google ScholarPubMed
14.Wood, EH, Heppner, RL, Weidmann, S. Inotropic effects of electric currents. I. Positive and negative effects of constant electric currents or current pulses applied during cardiac action potentials. II. Hypotheses: calcium movements, excitation–contraction coupling and inotropic effects. Circ Res 1969; 24: 409–445.CrossRefGoogle ScholarPubMed
15.Burkhoff, D, Shemer, I, Felzen, B 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.CrossRefGoogle ScholarPubMed
16.Bouchard, RA, Clark, RB, Giles, WR. Effects of action potential duration on excitation–contraction coupling in rat ventricular myocytes. Action potential voltage-clamp measurements. Circ Res 1995; 76: 790–801.CrossRefGoogle ScholarPubMed
17.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.CrossRefGoogle ScholarPubMed
18.Pappone, C, Rosanio, S, Burkhoff, D 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.CrossRefGoogle ScholarPubMed
19.Pappone, C, Augello, G, Rosanio, S 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.CrossRefGoogle ScholarPubMed
20.Neelagaru, SB, Sanchez, JE, Lau, SK et al. . Nonexcitatory, cardiac contractility modulation electrical impulses: feasibility study for advanced heart failure in patients with normal QRS duration. Heart Rhythm 2006; 3: 1140–1147.CrossRefGoogle ScholarPubMed
21.Booker, PD, Whyte, SD, Ladusans, EJ. Long QT syndrome and anaesthesia. Br J Anaesth 2003; 90: 349–366.CrossRefGoogle ScholarPubMed
22.Yildirim, H, Adanir, T, Atay, A, Katircioglu, K, Savaci, S. The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Eur J Anaesthesiol 2004; 21: 566–570.CrossRefGoogle ScholarPubMed
23. Impulse Dynamics. Patient’s Handbook OPTIMIZER III System. 2006; ID 00266, Rev. A.Google Scholar
24.Mark, JB, Slaughter, TF. Cardiovascular monitoring. In: Miller, RD, ed. Miller’s Anesthesia, 6th edn. Philadelphia: Elsevier Churchill Livingstone, 2005: 1265–1362.Google Scholar
25.Cholley, BP, Payen, D. Noninvasive techniques for measurements of cardiac output. Curr Opin Crit Care 2005; 11: 424–429.CrossRefGoogle ScholarPubMed
26.Horstkotte, D, Follath, F, Gutschik, E et al. . Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the task force on infective endocarditis of the European society of cardiology. Eur Heart J 2004; 25: 267–276.CrossRefGoogle ScholarPubMed