<unk>  is a therapy which is intended for the treatment of patients with moderate to severe heart failure (NYHA class II–IV) with symptoms despite optimal medical therapy who can benefit from an improvement in<unk>  output. The short- and long-term use of this therapy enhances the strength of ventricular contraction and therefore the heart's pumping capacity by<unk> g (adjusting) the myocardial<unk> . This is provided by a pacemaker-like device that applies non-excitatory electrical signals adjusted to and synchronized with the electrical action in the<unk>  cycle. In<unk>  therapy, electrical stimulation is applied to the<unk>  muscle during the absolute refractory period. In this phase of the<unk>  cycle, electrical signals cannot trigger new<unk>  muscle contractions, hence this type of stimulation is known as a non-excitatory stimulation. However, the electrical signals increase the influx of calcium ions into the<unk>  muscle cells (cardiomyocytes). In contrast to other electrical stimulation treatments for heart failure, such as pacemaker therapy or implantable cardioverter defibrillators (ICD),<unk>  does not directly affect<unk>  rhythm. Rather, the aim is to enhance the heart's natural contraction (the native<unk><unk>  sustainably over long periods of time. Furthermore, unlike most interventions that increase<unk><unk> ,<unk>  is not associated with an unfavorable increase in oxygen demand by the heart (measured in terms of Myocardial Oxygen Consumption or MVO2). This may be explained by the beneficial effect the therapy has in improving<unk>  efficiency. A meta-analysis in 2014 and an overview of device-based treatment options in heart failure in 2013 concluded that<unk>  treatment is safe, that it is generally beneficial to patients and that the treatment increases the exercise tolerance (ET) and quality of life (QoL) of patients. Furthermore, preliminary long-term survival data shows that<unk>  is associated with lower long-term mortality in heart failure patients when compared with expected rates among similar patients not treated with<unk> .
Cardiac contractility modulation
Vascular recruitment
Isolytic muscle contraction
Neural facilitation
Local blood flow regulation
Vasodilation
Vasoconstriction
Cardioprotection