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Sherwin ED, Shah MJ. Leadless Pacemakers in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:421-432. [PMID: 37865516 DOI: 10.1016/j.ccep.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Transcatheter leadless pacemakers have benefits in congenital heart disease because they eliminate the risks of lead malfunction, venous occlusions, and pocket complications. This newest pacemaker's utility in this population has been limited by the large sheath and delivery system, need for atrioventricular synchronous pacing, lack of explantation options, and possible lack of adequate access to the subpulmonary ventricle. With careful planning, leadless pacing can be successfully performed in these patients. Consideration of nonfemoral access, alternative implant sites to avoid myocardial scar or prosthetic material, anticoagulation for patients with persistent intracardiac shunts or systemic ventricular implantation, and operator experience are critical.
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Affiliation(s)
- Elizabeth D Sherwin
- Division of Pediatric Cardiology, Children's National Hospital, Division of Cardiology Washington, 111 Michigan Avenue, NW, Washington, DC 20010, USA
| | - Maully J Shah
- Cardiac Electrophysiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Ausra J, Madrid M, Yin RT, Hanna J, Arnott S, Brennan JA, Peralta R, Clausen D, Bakall JA, Efimov IR, Gutruf P. Wireless, fully implantable cardiac stimulation and recording with on-device computation for closed-loop pacing and defibrillation. SCIENCE ADVANCES 2022; 8:eabq7469. [PMID: 36288311 PMCID: PMC9604544 DOI: 10.1126/sciadv.abq7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Monitoring and control of cardiac function are critical for investigation of cardiovascular pathophysiology and developing life-saving therapies. However, chronic stimulation of the heart in freely moving small animal subjects, which offer a variety of genotypes and phenotypes, is currently difficult. Specifically, real-time control of cardiac function with high spatial and temporal resolution is currently not possible. Here, we introduce a wireless battery-free device with on-board computation for real-time cardiac control with multisite stimulation enabling optogenetic modulation of the entire rodent heart. Seamless integration of the biointerface with the heart is enabled by machine learning-guided design of ultrathin arrays. Long-term pacing, recording, and on-board computation are demonstrated in freely moving animals. This device class enables new heart failure models and offers a platform to test real-time therapeutic paradigms over chronic time scales by providing means to control cardiac function continuously over the lifetime of the subject.
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Affiliation(s)
- Jokubas Ausra
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Micah Madrid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Rose T. Yin
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Jessica Hanna
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Suzanne Arnott
- Department of Surgery, The George Washington University, Washington, DC 20037, USA
| | - Jaclyn A. Brennan
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Roberto Peralta
- Department of Aerospace and Mechanical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - David Clausen
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Jakob A. Bakall
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Igor R. Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Biomedical Engineering, Northwestern University, Chicago IL 60611, USA
- Department of Medicine (Cardiology), Northwestern University, Chicago, IL 60611, USA
| | - Philipp Gutruf
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
- Department of Electrical and Computer Engineering, The University of Arizona, Tucson, AZ 85721, USA
- Bio5 Institute, The University of Arizona, Tucson, AZ 85721, USA
- Neuroscience Graduate Interdisciplinary Program (GIDP), The University of Arizona, Tucson, AZ 85721, USA
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