{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:50:54Z","timestamp":1785905454863,"version":"3.56.0"},"reference-count":53,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Cardiac contractility modulation (CCM) is an implantable device-based therapy that delivers biphasic, non-excitatory electrical signals to the ventricular myocardium during the absolute refractory period. By enhancing contractile performance without inducing depolarization or altering ventricular activation, CCM acts as bioelectronic myocardial conditioning. Current evidence supports its use in selected patients with symptomatic heart failure, reduced or mildly reduced left ventricular ejection fraction, narrow QRS duration, persistent symptoms despite guideline-directed medical therapy, and no indication for cardiac resynchronization therapy. In this population, CCM improves functional status and quality of life, whereas evidence for reductions in mortality or recurrent heart failure hospitalization remains less definitive. Whether CCM also reduces arrhythmic burden remains uncertain. Candidates for CCM frequently exhibit atrial and ventricular remodeling, neurohormonal activation, implantable cardioverter-defibrillators, and vulnerability to atrial fibrillation, ventricular arrhythmias, and device therapies. Mechanistically, CCM may render the failing myocardium less arrhythmogenic through coordinated effects on calcium handling, electromechanical remodeling, fibrosis-related substrate, contractile efficiency, and heart-failure stability. However, pivotal trials were not designed to assess arrhythmic endpoints, leaving the relationship between CCM and arrhythmic burden insufficiently characterized. This review summarizes CCM evidence, mechanistic rationale, available arrhythmic signals, device-related considerations, and future research priorities for prospective studies in this evolving field.<\/jats:p>","DOI":"10.3390\/jcdd13080362","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T10:24:07Z","timestamp":1785752647000},"page":"362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Contractility Modulation and Arrhythmic Burden in Heart Failure: Mechanistic Rationale, Clinical Evidence, and Future Perspectives"],"prefix":"10.3390","volume":"13","author":[{"given":"Andrea","family":"Palermi","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, G. d\u2019Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy"},{"name":"Arrhythmology Unit, \u201cSS. Annunziata\u201d Hospital, Via dei Vestini 31, 66100 Chieti, Italy"},{"name":"Department of Cardiology, \u201cS. Pio da Pietrelcina\u201d Hospital, 66054 Vasto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3815-457X","authenticated-orcid":false,"given":"Silvio","family":"Saraullo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, G. d\u2019Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy"},{"name":"Department of Cardiology, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Faustino","sequence":"additional","affiliation":[{"name":"Arrhythmology Unit, \u201cSS. Annunziata\u201d Hospital, Via dei Vestini 31, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Sacchetta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Magnano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Mazzocchetti","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cPierangeli\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Guarracini","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cPierangeli\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cSanto Spirito\u201d Hospital, 65124 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanda","family":"Furia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cS. Pio da Pietrelcina\u201d Hospital, 66054 Vasto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0263-4851","authenticated-orcid":false,"given":"Sabina","family":"Gallina","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, G. d\u2019Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy"},{"name":"University Cardiology Unit, Heart Department, \u201cSS. Annunziata\u201d Hospital, Via dei Vestini 31, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4770-8386","authenticated-orcid":false,"given":"Giulia","family":"Renda","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, G. d\u2019Annunzio University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy"},{"name":"University Cardiology Unit, Heart Department, \u201cSS. Annunziata\u201d Hospital, Via dei Vestini 31, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1038\/nrcardio.2013.114","article-title":"Cardiac Contractility Modulation Therapy in Advanced Systolic Heart Failure","volume":"10","author":"Lyon","year":"2013","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/ejhf.1349","article-title":"Cardiac Contractility Modulation: Mechanisms of Action in Heart Failure with Reduced Ejection Fraction and Beyond","volume":"21","author":"Kherad","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/j.ehj.2004.02.027","article-title":"Chronic Electrical Stimulation during the Absolute Refractory Period of the Myocardium Improves Severe Heart Failure","volume":"25","author":"Stix","year":"2004","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.hrthm.2006.06.031","article-title":"Nonexcitatory, Cardiac Contractility Modulation Electrical Impulses: Feasibility Study for Advanced Heart Failure in Patients with Normal QRS Duration","volume":"3","author":"Neelagaru","year":"2006","journal-title":"Heart Rhythm."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1093\/eurheartj\/ehn020","article-title":"Randomized, Double-Blind Study of Non-Excitatory, Cardiac Contractility Modulation Electrical Impulses for Symptomatic Heart Failure","volume":"29","author":"Borggrefe","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.ahj.2010.10.025","article-title":"A Randomized Controlled Trial Evaluating the Safety and Efficacy of Cardiac Contractility Modulation in Advanced Heart Failure","volume":"161","author":"Kadish","year":"2011","journal-title":"Am. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.jchf.2018.04.010","article-title":"A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation","volume":"6","author":"Abraham","year":"2018","journal-title":"JACC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2922","DOI":"10.1002\/ehf2.12902","article-title":"A Comprehensive Individual Patient Data Meta-Analysis of the Effects of Cardiac Contractility Modulation on Functional Capacity and Heart Failure-Related Quality of Life","volume":"7","author":"Giallauria","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_9","first-page":"e10627","article-title":"All-Cause Mortality Outcomes of Usage of Cardiac Contractility Modulation in Patients with Dilated Cardiomyopathy Ineligible for Cardiac Resynchronization Therapy: An Updated Meta-Analysis of Randomized Controlled Trials","volume":"12","author":"Nadeem","year":"2020","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1002\/ejhf.1374","article-title":"Cardiac Contractility Modulation Improves Long-Term Survival and Hospitalizations in Heart Failure with Reduced Ejection Fraction","volume":"21","author":"Anker","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1002\/ejhf.2202","article-title":"Long-Term Clinical Experience with Cardiac Contractility Modulation Therapy Delivered by the Optimizer Smart System","volume":"23","author":"Kuschyk","year":"2021","journal-title":"Eur. J. Heart Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1007\/s00392-017-1135-9","article-title":"Clinical Effects of Long-Term Cardiac Contractility Modulation in Subjects with Heart Failure Caused by Left Ventricular Systolic Dysfunction","volume":"106","author":"Remppis","year":"2017","journal-title":"Clin. Res. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s00399-025-01118-1","article-title":"Cardiac Contractility Modulation: An Update","volume":"36","author":"Kuschyk","year":"2025","journal-title":"Herzschrittmacherther. Elektrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Masarone, D., Kittleson, M.M., De Vivo, S., D\u2019Onofrio, A., Ammendola, E., Nigro, G., Contaldi, C., Martucci, M.L., Errigo, V., and Pacileo, G. (2022). The Effects of Device-Based Cardiac Contractility Modulation Therapy on Left Ventricle Global Longitudinal Strain and Myocardial Mechano-Energetic Efficiency in Patients with Heart Failure with Reduced Ejection Fraction. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195866"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"ehab724.0135","DOI":"10.1093\/eurheartj\/ehab724.0135","article-title":"The Assessment of Left Ventricular Myocardial Work in Patients with Chronic Heart Failure Receiving Cardiac Contractility Modulation Therapy","volume":"42","author":"Dobrovolskaya","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1016\/j.cardfail.2025.07.028","article-title":"Effects of Cardiac Contractility Modulation Therapy on Cardiac Hemodynamics: Focus on Myocardial Work","volume":"31","author":"Masarone","year":"2025","journal-title":"J. Card. Fail."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Raab, C., Roehl, P., Wiora, M., and Ebelt, H. (2025). Cardiac Contractility Modulation Improves Left Ventricular Function, Including Global Longitudinal Strain, in Patients with Chronic Heart Failure. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072251"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_19","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1002\/ejhf.2619","article-title":"Cardiac Contractility Modulation Therapy Improves Health Status in Patients with Heart Failure with Preserved Ejection Fraction: A Pilot Study","volume":"24","author":"Linde","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_21","unstructured":"(2026, June 25). Assessment of Implantable CCM in the Heart Failure Group with Higher Ejection Fraction (AIM HIGHer), Available online: https:\/\/clinicaltrials.gov\/study\/NCT05064709."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1093\/europace\/eun257","article-title":"Cardiac Contractility Modulation in Non-Responders to Cardiac Resynchronization Therapy","volume":"10","author":"Behrens","year":"2008","journal-title":"Europace"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e006512","DOI":"10.1161\/CIRCHEARTFAILURE.119.006512","article-title":"Safety, Performance, and Efficacy of Cardiac Contractility Modulation Delivered by the 2-Lead Optimizer Smart System: The FIX-HF-5C2 Study","volume":"13","author":"Wiegn","year":"2020","journal-title":"Circ. Heart Fail."},{"key":"ref_24","first-page":"1064","article-title":"Impact of Baseline Left Ventricular Ejection Fraction on Long-Term Outcomes in Cardiac Contractility Modulation Therapy","volume":"45","author":"Fastner","year":"2022","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1093\/europace\/euu050","article-title":"Cardiac Contractility Modulation: First Experience in Heart Failure Patients with Reduced Ejection Fraction and Permanent Atrial Fibrillation","volume":"16","author":"Schneider","year":"2014","journal-title":"Europace"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1097\/MJT.0000000000001579","article-title":"One-Year Outcome of Cardiac Contractility Modulation in Patients with Reduced Ejection Fraction, Atrial Fibrillation, and Previous Resynchronization: A Pilot Study","volume":"30","author":"Tint","year":"2023","journal-title":"Am. J. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5202","DOI":"10.19102\/icrm.2022.13104","article-title":"Does Cardiac Contractility Modulation Therapy Reduce Atrial Fibrillation Burden?","volume":"13","author":"Shin","year":"2022","journal-title":"J. Innov. Card. Rhythm Manag."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"102997","DOI":"10.1016\/j.jaccas.2024.102997","article-title":"Effects of Cardiac Contractility Modulation in a Patient with Heart Failure and High Arrhythmic Burden","volume":"30","author":"Ottaviani","year":"2025","journal-title":"JACC Case Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ehf2.14575","article-title":"Enhancing Myocardial Function with Cardiac Contractility Modulation: Potential and Challenges","volume":"11","author":"Li","year":"2024","journal-title":"ESC Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1016\/j.jacc.2006.10.082","article-title":"Therapy with Cardiac Contractility Modulation Electrical Signals Improves Left Ventricular Function and Remodeling in Dogs with Chronic Heart Failure","volume":"49","author":"Imai","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1016\/j.jacc.2008.01.036","article-title":"Cardiac Contractility Modulation Electrical Signals Improve Myocardial Gene Expression in Patients with Heart Failure","volume":"51","author":"Butter","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1159\/000112405","article-title":"Effects of Chronic Therapy with Cardiac Contractility Modulation Electrical Signals on Cytoskeletal Proteins and Matrix Metalloproteinases in Dogs with Heart Failure","volume":"110","author":"Rastogi","year":"2008","journal-title":"Cardiology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.cardfail.2008.08.011","article-title":"Cardiac Contractility Modulation Electrical Signals Normalize Activity, Expression, and Phosphorylation of the Na+\/Ca2+ Exchanger in Heart Failure","volume":"15","author":"Gupta","year":"2009","journal-title":"J. Card. Fail."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1752-8062.2009.00097.x","article-title":"Ca2+-Binding Proteins in Dogs with Heart Failure: Effects of Cardiac Contractility Modulation Electrical Signals","volume":"2","author":"Gupta","year":"2009","journal-title":"Clin. Transl. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"300060520962910","DOI":"10.1177\/0300060520962910","article-title":"Cardiac Contractility Modulation Attenuates Structural and Electrical Remodeling in a Chronic Heart Failure Rabbit Model","volume":"48","author":"Ning","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Lyasnikova, E., Sukhareva, K., Vander, M., Zaitsev, K., Firulyova, M., Sergushichev, A., Sorokina, M., Trukshina, M., Galenko, V., and Lelyavina, T. (2024). Molecular Effects of Cardiac Contractility Modulation in Patients with Heart Failure of Ischemic Aetiology Uncovered by Transcriptome Analysis. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1321005"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.jcmg.2009.07.011","article-title":"Impact of Cardiac Contractility Modulation on Left Ventricular Global and Regional Function and Remodeling","volume":"2","author":"Yu","year":"2009","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1007\/s00259-011-1977-8","article-title":"The Effect of Device-Based Cardiac Contractility Modulation Therapy on Myocardial Efficiency and Oxidative Metabolism in Patients with Heart Failure","volume":"39","author":"Goliasch","year":"2012","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1093\/eurjhf\/hfs078","article-title":"Clinical Effects of Cardiac Contractility Modulation as a Treatment for Chronic Heart Failure","volume":"14","author":"Borggrefe","year":"2012","journal-title":"Eur. J. Heart Fail."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1093\/cvr\/cvn133","article-title":"Remodelling of Gap Junctions and Connexin Expression in Diseased Myocardium","volume":"80","author":"Severs","year":"2008","journal-title":"Cardiovasc. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0008-6363(01)00324-8","article-title":"Cardiac Gap Junction Channels: Modulation of Expression and Channel Properties","volume":"51","author":"Opthof","year":"2001","journal-title":"Cardiovasc. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0008-6363(01)00341-8","article-title":"High-Resolution Optical Mapping Reveals Conduction Slowing in Connexin43-Deficient Mice","volume":"51","author":"Eloff","year":"2001","journal-title":"Cardiovasc. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1016\/j.jacc.2012.04.042","article-title":"Connexin43 Gene Transfer Reduces Ventricular Tachycardia Susceptibility after Myocardial Infarction","volume":"60","author":"Greener","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1056\/NEJM199108293250905","article-title":"Evidence of a Selective Increase in Cardiac Sympathetic Activity in Patients with Sustained Ventricular Arrhythmias","volume":"325","author":"Meredith","year":"1991","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/S0002-8703(97)80011-7","article-title":"Depressed Arterial Baroreflex Sensitivity and Not Reduced Heart Rate Variability Identifies Patients with Chronic Heart Failure and Nonsustained Ventricular Tachycardia: The Effect of High Ventricular Filling Pressure","volume":"134","author":"Mortara","year":"1997","journal-title":"Am. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Wessel, N., Berg, K., Kraemer, J.F., Gapelyuk, A., Rietsch, K., Hauser, T., Kurths, J., Wenzel, D., Klein, N., and Kolb, C. (2020). Cardiac Autonomic Dysfunction and Incidence of de novo Atrial Fibrillation: Heart Rate Variability vs. Heart Rate Complexity. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.596844"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1093\/europace\/eur153","article-title":"Long-Term Outcome of Cardiac Contractility Modulation in Patients with Severe Congestive Heart Failure","volume":"13","author":"Schau","year":"2011","journal-title":"Europace"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ijcard.2014.12.178","article-title":"Efficacy and Survival in Patients with Cardiac Contractility Modulation: Long-Term Single-Center Experience in 81 Patients","volume":"183","author":"Kuschyk","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/clc.22919","article-title":"Long-Term Results of Combined Cardiac Contractility Modulation and Subcutaneous Implantable Cardioverter-Defibrillator Therapy in Patients with Heart Failure and Reduced Ejection Fraction","volume":"41","author":"Rudic","year":"2018","journal-title":"Clin. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/jce.15198","article-title":"Device Interaction between Cardiac Contractility Modulation and Subcutaneous Implantable Cardioverter-Defibrillator","volume":"32","author":"Trolese","year":"2021","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_51","unstructured":"(2026, June 25). Combined Cardiac Contractility Modulation and Implantable Cardioverter-Defibrillator Study\/OPTIMIZER Integra CCM-D System (INTEGRA-D), Available online: https:\/\/clinicaltrials.gov\/study\/NCT05855135."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/1532-429X-14-62","article-title":"Infarct Healing Is a Dynamic Process Following Acute Myocardial Infarction","volume":"14","author":"Pokorney","year":"2012","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e007792","DOI":"10.1161\/CIRCEP.119.007792","article-title":"Accurate Conduction Velocity Maps and Their Association with Scar Distribution on Magnetic Resonance Imaging in Patients with Postinfarction Ventricular Tachycardias","volume":"13","author":"Aronis","year":"2020","journal-title":"Circ. Arrhythmia Electrophysiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/362\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:30:43Z","timestamp":1785904243000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":53,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcdd13080362"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13080362","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}