Major advances have been made over the past two decades in the pharmacologic treatment of chronic heart failure (HF). Angiotensin-converting enzyme inhibitors, beta-blockers, and aldosterone antagonists have had a substantial impact on reducing mortality and morbidity in patients with HF and low left ventricular ejection fraction. These treatments delayed the progression toward advanced intractable HF but did not arrest progressive worsening of the disease. Patients on optimal medical therapy continued to deteriorate, albeit at a much slower pace, ultimately requiring further intervention. This gave rise to a host of device-based therapies that emerged in recent years to address this unmet need. Device therapies such as cardiac resynchronization, the CorCap cardiac support device (Acorn Cardiovascular, Inc., St. Paul, MN), and the OPTIMIZER System (Impulse Dynamics USA, Inc., Orangeburg, NY) are a few examples. This review addresses the progress made to date in the development and implementation of cardiac contractility modulation (CCM) as a device-based therapy for the treatment of patients with advanced HF. Treatment of patients with HF using CCM electrical signals is at present an investigational form of therapy.