Abstract
BACKGROUND: Cardiac contractility modulation (CCM) improves myocardial contractility and heart failure (HF) symptoms, whereas the extravascular implantable cardioverter-defibrillator (EV-ICD) offers defibrillation without transvenous leads. Their combined use has not been previously reported. FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: This case presents the first documented implantation of CCM therapy in a patient with a prior EV-ICD. Lead placement and programming were optimized to prevent interference. Both devices functioned independently, with stable sensing and no inappropriate therapies. The patient experienced improved HF symptoms. DISCUSSION: This case demonstrates the feasibility and safety of integrating CCM and EV-ICD therapy, highlighting the importance of strategic lead positioning and programming. NOVELTY: This is the first report of CCM and EV-ICD integration, demonstrating their complementary role in HF management. TAKE-HOME MESSAGE: CCM and EV-ICD can be safely combined, expanding options for HF patients requiring both therapies.