Artificial neural interfaces for bionic cardiovascular treatments

Dynamic detection and reversal of myocardial ischemia using an artificially intelligent bioelectronic medicine

Myocardial ischemia is spontaneous, frequently asymptomatic, and contributes to fatal cardiovascular consequences. Importantly, myocardial sensory networks cannot reliably detect and correct myocardial ischemia on their own. Here, we demonstrate an artificially intelligent and responsive bioelectronic medicine, where an artificial neural network (ANN) supplements myocardial sensory networks, enabling reliable detection and correction of myocardial ischemia. ANNs were first trained to decode spontaneous cardiovascular stress and myocardial ischemia with an overall accuracy of ~92%. ANN-controlled vagus nerve stimulation (VNS) significantly mitigated major physiological features of myocardial ischemia, including ST depression and arrhythmias. In contrast, open-loop VNS or ANN-controlled VNS following a caudal vagotomy essentially failed to reverse cardiovascular pathophysiology. Last, variants of ANNs were used to meet clinically relevant needs, including interpretable visualizations and unsupervised detection of emerging cardiovascular stress. Overall, these preclinical results suggest that ANNs can potentially supplement deficient myocardial sensory networks via an artificially intelligent bioelectronic medicine system.

A novel approach to the design of an artificial bionic baroreflex

This paper presents a computationally efficient method to design an artificial bionic baroreflex. This work is built upon a physiology-based mathematical model of autonomic-cardiac regulation describing the regulation of heart rate and blood pressure as well as a system identification technique to identify a subject-specific mathematical model for each subject. The control strategy to regulate blood pressure is developed based upon the in-vivo baroreflex mechanism. A unique strength of the proposed method is its capability to determine the modulating baroreflex functions on the sympathetic and parasympathetic nerve activities. This method can be used in the treatment of individuals with baroreflex failure through overriding the corresponding nerves to properly regulate blood pressure. In fact, nerve overriding causes heart rate and arterial stiffness to adjust such that blood pressure reaches a proper range to provide enough oxygenated-blood to the critical organs.

Anatomical observations of the caudal vestibulo-sympathetic pathway

The vestibular system senses the movement and position of the head in space and uses this information to stabilize vision, control posture, perceive head orientation and self-motion in three-dimensional space, and modulate autonomic and limbic activity in response to locomotion and changes in posture. Most vestibular signals are not consciously perceived and are usually appreciated through effector pathways classically described as the vestibulo-ocular, vestibulo-spinal, vestibulo-collic and vestibulo-autonomic reflexes. The present study reviews some of the recent data concerning the connectivity and chemical anatomy of vestibular projections to autonomic sites that are important in the sympathetic control of blood pressure.

Bionic cardiology: exploration into a wealth of controllable body parts in the cardiovascular system

Bionic cardiology is the medical science of exploring electronic control of the body, usually via the neural system. Mimicking or modifying biological regulation is a strategy used to combat diseases. Control of ventricular rate during atrial fibrillation by selective vagal stimulation, suppression of ischemia-related ventricular fibrillation by vagal stimulation, and reproduction of neurally commanded heart rate are some examples of bionic treatment for arrhythmia. Implantable radio-frequency-coupled on-demand carotid sinus stimulators succeeded in interrupting or preventing anginal attacks but were replaced later by coronary revascularization. Similar but fixed-intensity carotid sinus stimulators were used for hypertension but were also replaced by drugs. Recently, however, a self-powered implantable device has been reappraised for the treatment of drug-resistant hypertension. Closed-loop spinal cord stimulation has successfully treated severe orthostatic hypotension in a limited number of patients. Vagal nerve stimulation is effective in treating heart failure in animals, and a small-size clinical trial has just started. Simultaneous corrections of multiple hemodynamic abnormalities in an acute decompensated state are accomplished simply by quantifying fundamental cardiovascular parameters and controlling these parameters. Bionic cardiology will continue to promote the development of more sophisticated device-based therapies for otherwise untreatable diseases and will inspire more intricate applications in the twenty-first century.