Cardiac contractility modulation in the treatment of heart failure: initial results and unanswered questions.

Despite advances in our understanding of the pathology of heart failure modern conventional pharmacological therapies have proved insufficient. The application of electrical impulses during the refractory period of the cardiac contractile cycle, so-called cardiac contractility modulation (CCM), presents a new therapeutic approach with promising results demonstrated in clinical trials to date. The mechanism by which CCM exerts its effects remains inconclusive with conflicting reports. This article provides a concise review of the experimental and clinical CCM studies conducted to date with particular focus on areas of controversy and unexplored avenues of interest with this novel electrical therapy.