Understanding the Optimizer® System for Heart Failure Support

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When someone is diagnosed with heart failure, this means their heart does not pump blood as well as it should. This may lead to fatigue, shortness of breath and other symptoms. The Impulse Dynamics Optimizer system supports some patients with heart failure by helping the heart to contract more effectively. This system is one among several heart failure treatment options. Decisions about its use are made carefully based on a person’s specific condition and needs.

What Is the Optimizer System?

The Optimizer smart system is not meant for everyone with heart failure. It is designed for adults with a reduced ejection fraction (a measure of how well the heart pumps) who still have symptoms despite medication and aren’t candidates for cardiac resynchronization therapy (CRT). Doctors assess several factors to determine whether this therapy might be appropriate.

The Optimizer is an implantable heart failure device that helps the heart beat more effectively by sending small electrical pulses to the heart muscle. These pulses are delivered during a specific part of the heartbeat, known as the absolute refractory period when the heart is not actively contracting. This is called cardiac contractility modulation therapy.

Unlike a pacemaker or defibrillator, the Optimizer system doesn’t make the heart beat or shock it during dangerous rhythms. Instead, it works alongside the heart’s natural rhythm to support stronger contractions. This may help improve how the heart pumps blood, particularly in people with certain types of heart failure who don’t qualify for other device-based treatments.

How Does the Optimizer System Work?

The goal of the cardiac contractility modulation device therapy with the Optimizer is to support the heart’s natural contractions without forcing the heart to beat. The device system’s key components include:

A pulse generator is a small device implanted just under the skin in the upper chest.
Leads, or thin wires, are placed inside the heart (usually the right ventricular septum). These deliver the CCM signals directly to the heart muscle.
An external programming system, which the medical team uses to adjust the device settings after it’s implanted.

The Optimizer is programmed to deliver cardiac contractility modulation (CCM) therapy for a few hours daily. This happens automatically based on the schedule set by the healthcare provider. The pulses from the device don’t make the heart muscle contract or interfere with the heart’s normal rhythm. Instead, they affect the heart cells in a way that may help improve how strongly the heart contracts over time.

How Does the Optimizer System Improve Heart Function?

Every time your heart beats, it relies on a careful balance of electrical signals and muscle activity. The Optimizer system works by sending brief electrical pulses to the heart muscle during a part of the heartbeat cycle when the heart is not responding to normal electrical signals. These pulses don’t cause the heart to beat—they are unlike the shocks from a defibrillator or the pacing from a pacemaker.

Instead, they aim to improve how the heart muscle cells use calcium, a key part of how the heart contracts. Over time, this may help the heart contract more effectively, especially in the left ventricle—the main chamber responsible for pumping blood to the rest of the body.

What Are the Benefits of the Optimizer System for Heart Failure Patients?

The Optimizer system may offer the following benefits:

Improved Heart Pumping Strength: The Optimizer system uses CCM therapy to help the heart muscle contract more effectively. This has been associated with improvements in the amount of blood the heart pumps with each beat, measured by something called ejection fraction.
Support for Daily Activities: Some people treated with CCM therapy have shown improved ability to perform everyday physical activities. This includes walking longer distances in walk tests, which may reflect better tolerance for activity.
Symptom Relief: Patients in clinical studies reported improvement in heart failure symptoms such as shortness of breath and fatigue. These symptoms can make daily life more difficult, and reducing them may help improve comfort and function.

How Is the Optimizer Device Implanted and Maintained?

After the Optimizer system implantation, the system doesn’t require daily interaction from the person using it. Regular follow-up visits are used to check the device and make adjustments if needed. The system includes safety features that pause therapy if the heart rate goes above a certain level, avoiding therapy during abnormal heart rhythms.

The Optimizer system is not a pacemaker or a defibrillator. It does not take over the job of the heart. It works alongside the heart’s natural rhythm, aiming to support more effective contractions in people with specific types of heart failure who continue to have symptoms despite medication and are not candidates for other device therapies.

Before the Procedure

A healthcare team will review your heart condition, symptoms, and medical history to determine if the Optimizer system is appropriate for you. If it is, they will explain the procedure, what to expect and answer any questions. You may have tests done, such as imaging or heart rhythm monitoring, to help plan the placement of the device.

During the Procedure

The Optimizer device is implanted during a minimally invasive procedure, usually done under local anesthesia with sedation. The device is placed under the skin in the upper chest, typically on the right side. One or more thin wires, called leads, are guided through a vein and positioned inside the heart. These leads deliver CCM signals to the heart muscle.

The device is tested before the procedure ends to make sure it is sensing and delivering therapy correctly. The incision is then closed, and the device begins to deliver therapy at scheduled times during the day.

After the Procedure

You may stay in the hospital overnight or longer, depending on your recovery and medical needs. Your healthcare team will monitor your heart and the device. Once home, you'll need follow-up visits to check the device and make sure it’s working properly. The settings may be adjusted based on your response and how your heart is functioning.

The Optimizer device's battery typically lasts around 20 years. While you won’t need to recharge it yourself, it does require regular checkups to monitor its function and battery status. Your care team will use a special programmer to review data and adjust settings when needed.

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