Anaesthesia and cardiac contractility modulation.

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.