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

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.

Artificial baroreflex system restores volume tolerance in the absence of native baroreflex

The arterial baroreflex stabilizes arterial pressure by modulating the mechanical properties of cardiovascular system. We previously demonstrated that the baroreflex impairment makes the circulatory system extremely sensitive to volume overload and predisposes to pulmonary edema irrespective of left ventricular systolic function. To overcome the volume intolerance, we developed an artificial baroreflex system by directly stimulating the carotid sinus nerves in response to changes in arterial pressure. The artificial baroreflex system precisely reproduced the native arterial pressure response and restored physiological volume buffering function. We conclude that the artificial baroreflex system would be an attractive tool in preventing pulmonary edema in patients with impaired baroreflex function.

Development of artificial bionic baroreflex system

The baroreflex system is the fastest mechanism in the body to regulate arterial pressure. Because the neural system (i.e., autonomic nervous system) mediates the baroreflex and the system operates under the closed-loop condition, the quantitative dynamic characteristics of the baroreflex system remained unknown until recently despite the fact that a countless number of observational and qualitative studies had been conducted. In order to develop the artificial baroreflex system, i.e., the bionic baroreflex system, we first anatomically isolated the carotid sinuses to open the baroreflex loop and identified the open-loop transfer function of the baroreflex system using white noise pressure perturbations. We found that the baroreflex system is basically a lowpass filter and remarkably linear. As an actuator to implement the bionic baroreflex system, we then stimulated the sympathetic efferent nerves at various parts of the baroreflex loop and identified the transfer functions from the stimulation sites to systemic arterial pressure. We found that the actuator responses can be described remarkably well with linear transfer functions. Since transfer functions of the native baroreflex and of the actuator were identified, the controller that is required to reproduce the native baroreflex transfer function can be easily derived from those transfer functions. To examine the performance of bionic baroreflex system, we implemented it animal models of baroreflex failure. The bionic baroreflex system restored normal arterial pressure regulation against orthostatic stresses that is indistinguishable from the native baroreflex system.