achieved if the electrical signals were applied not only to single cells but to large areas using larger leads, as used in conventional cardiac pacemakers. The contractility of both a healthy heart and a damaged heart could be increased through application of appropriate signals during the absolute refractory period of the cardiac muscle cells. An implantable cardiac contractility modulation device was received by a patient for the first time in 2001. The first study on the therapeutic effects of in humans was presented in 2004. To date, more than 3,000 heart failure patients have been treated with cardiac contractility modulation worldwide, including 641 patients under the study conditions recommended by the Cochrane Collaboration as being necessary for inclusion in a meta-analysis. Cardiac contractility modulation device implantation was first successfully done in India in Royal Hospital, Trivandrum, Kerala, under the leadership of Dr. C. Bharath Chandran. Advocate Harishankar was the first person in India to get the cardiac contractility modulation device implanted. See also Heart Cardiac cycle Heart failure Artificial cardiac pacemaker Implantable cardioverter-defibrillator NYHA classification Cardiac resynchronization therapy References External links Current assessment of new device therapies for heart failure by the European Heart Rhythm Association (EHRA) – includes Cardiac contractility modulation Cardiac procedures