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Mahmoudi N, Mohamed E, Dehnavi SS, Aguilar LMC, Harvey AR, Parish CL, Williams RJ, Nisbet DR. Calming the Nerves via the Immune Instructive Physiochemical Properties of Self-Assembling Peptide Hydrogels. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2303707. [PMID: 38030559 PMCID: PMC10837390 DOI: 10.1002/advs.202303707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/22/2023] [Indexed: 12/01/2023]
Abstract
Current therapies for the devastating damage caused by traumatic brain injuries (TBI) are limited. This is in part due to poor drug efficacy to modulate neuroinflammation, angiogenesis and/or promoting neuroprotection and is the combined result of challenges in getting drugs across the blood brain barrier, in a targeted approach. The negative impact of the injured extracellular matrix (ECM) has been identified as a factor in restricting post-injury plasticity of residual neurons and is shown to reduce the functional integration of grafted cells. Therefore, new strategies are needed to manipulate the extracellular environment at the subacute phase to enhance brain regeneration. In this review, potential strategies are to be discussed for the treatment of TBI by using self-assembling peptide (SAP) hydrogels, fabricated via the rational design of supramolecular peptide scaffolds, as an artificial ECM which under the appropriate conditions yields a supramolecular hydrogel. Sequence selection of the peptides allows the tuning of these hydrogels' physical and biochemical properties such as charge, hydrophobicity, cell adhesiveness, stiffness, factor presentation, degradation profile and responsiveness to (external) stimuli. This review aims to facilitate the development of more intelligent biomaterials in the future to satisfy the parameters, requirements, and opportunities for the effective treatment of TBI.
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Affiliation(s)
- Negar Mahmoudi
- Laboratory of Advanced Biomaterials, the John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
- ANU College of Engineering & Computer Science, Australian National University, Canberra, ACT, 2601, Australia
- The Graeme Clark Institute, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Elmira Mohamed
- Laboratory of Advanced Biomaterials, the John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
| | - Shiva Soltani Dehnavi
- Laboratory of Advanced Biomaterials, the John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
- ANU College of Engineering & Computer Science, Australian National University, Canberra, ACT, 2601, Australia
| | - Lilith M Caballero Aguilar
- Laboratory of Advanced Biomaterials, the John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
- The Graeme Clark Institute, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Alan R Harvey
- School of Human Sciences, The University of Western Australia, and Perron Institute for Neurological and Translational Science, Perth, WA, 6009, Australia
| | - Clare L Parish
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia
| | - Richard J Williams
- IMPACT, School of Medicine, Deakin University, Geelong, VIC, 3217, Australia
| | - David R Nisbet
- Laboratory of Advanced Biomaterials, the John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
- The Graeme Clark Institute, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, VIC, 3010, Australia
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Stritecky J, Kremlacek J, Hanus J, Haman L, Stritecka H, Simka J, Parizek P. Capture threshold of bipolar and unipolar pacing of left ventricle via coronary sinus branch: longitudinal study. Front Cardiovasc Med 2023; 10:1096538. [PMID: 37288262 PMCID: PMC10242161 DOI: 10.3389/fcvm.2023.1096538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/18/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The aim of this paper is to first monitor the changes in the capture threshold of endovascularly placed leads for left ventricle pacing, second to compare the pacing configurations, and third to verify the effect of Steroid elution for endovascular leads. Sample and Method The study included 202 consecutive single centre patients implanted with the Quartet™ lead (St. Jude Medical). The capture threshold and related lead parameters were tested during implantation, on the day of the patient's discharge, and 3, 9, and 15 months after implantation. The electrical energy corresponding to the threshold values for inducing ventricular contraction was recorded for subgroups of patients with bipolar and pseudo-unipolar pacing vectors and electrodes equipped with and without a slow-eluting steroids. The best setting for the resynchronization effect was generally chosen. Capture threshold was taken as a selection criterion only if there were multiple options with (expected) similar resynchronization effect. Results and Discussion The measurements showed that the ratio of threshold energies of UNI vs. BI was 5× higher (p < 0.001) at implantation. At the end of the follow-up, it dropped to 2.6 (p = 0.012). The steroid effect in BI vectors was caused by a double capture threshold in the NSE group compared to the SE group (p < 0.001), increased by approximately 2.5 times (p < 0.001). The study concludes that after a larger initial increase in the capture threshold, the leads showed a gradual increase in the entire set. As a result, the bipolar threshold energies increase, and the pseudo-unipolar energies decrease. Since bipolar vectors require a significantly lower pacing energy, battery life of the implanted device would improve. When evaluating the steroid elution of bipolar vectors, we observe a significant positive effect of a gradual increase of the threshold energy.
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Affiliation(s)
- Jakub Stritecky
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Kremlacek
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
| | - Josef Hanus
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
| | - Ludek Haman
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hana Stritecka
- Department of Military Internal Medicine and Military Hygiene, Faculty of Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Jakub Simka
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petr Parizek
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Terutsuki D, Yoroizuka H, Osawa SI, Ogihara Y, Abe H, Nakagawa A, Iwasaki M, Nishizawa M. Totally Organic Hydrogel-Based Self-Closing Cuff Electrode for Vagus Nerve Stimulation. Adv Healthc Mater 2022; 11:e2201627. [PMID: 36148587 DOI: 10.1002/adhm.202201627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/01/2022] [Indexed: 01/28/2023]
Abstract
An intrinsically soft organic electrode consisting of poly(3,4-ethylenedioxythiophene)-modified polyurethane (PEDOT-PU) is embedded into a bilayer film of polyvinyl alcohol (PVA) hydrogels for developing a self-closing cuff electrode for neuromodulation. The curled form of the PVA hydrogel is prepared by releasing internal stress in the bilayer structure. The inner diameter of the cuff electrode is set to less than 2 mm for immobilization to the vagus nerve (VN) of humans and pigs. The stability of the immobilization is examined, while the pressure applied to a nerve bundle is at a harmless level (≈200 Pa). Since the electrode is totally organic, MRI measurements can be conducted without image artifacts. The large electric capacitance of the PEDOT-PU (≈27 mF cm-2 ) ensures a safe stimulation of living tissues without Faradaic reactions. The practical performance of the cuff electrode for VN stimulation is demonstrated by observation of bradycardia induction in a pig.
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Affiliation(s)
- Daigo Terutsuki
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aoba, Aoba-ku, Sendai, 980-8579, Japan
| | - Hayato Yoroizuka
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aoba, Aoba-ku, Sendai, 980-8579, Japan
| | - Shin-Ichiro Osawa
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Yuka Ogihara
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aoba, Aoba-ku, Sendai, 980-8579, Japan
| | - Hiroya Abe
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aoba, Aoba-ku, Sendai, 980-8579, Japan
| | - Atsuhiro Nakagawa
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo, 187-8551, Japan
| | - Matsuhiko Nishizawa
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki Aoba, Aoba-ku, Sendai, 980-8579, Japan
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Shirwaiker A, William J, Mariani JA, Kistler PM, Patel HC, Voskoboinik A. Long-Term Implications of Pacemaker Insertion in Younger Adults: A Single Centre Experience. Heart Lung Circ 2022; 31:993-998. [PMID: 35219598 DOI: 10.1016/j.hlc.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The long-term implications of pacemaker insertion in younger adults are poorly described in the literature. METHODS We performed a retrospective analysis of consecutive younger adult patients (18-50 yrs) undergoing pacemaker implantation at a quaternary hospital between 1986-2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed. RESULTS Eighty-one (81) patients (median age 41.0 yrs IQR=35-47.0, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.9 (IQR=1.1-14.9) years follow-up, nine patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation [n=11], device infection [n=1] and pocket revision [n=1]). Five (5) of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further nine patients (11%) experienced pacemaker-related morbidity from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in two patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and seven of these patients required subsequent biventricular upgrade. Furthermore, four patients (5%) developed new tricuspid regurgitation (>moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients. CONCLUSIONS Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.
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Affiliation(s)
| | | | - Justin A Mariani
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia
| | - Peter M Kistler
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | - Hitesh C Patel
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Aleksandr Voskoboinik
- Heart Centre, Alfred Health, Melbourne, Vic, Australia; Monash University, Melbourne, Vic, Australia; The Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia.
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Zhao J, Huang Y, Lei L, Yao Z, Liu T, Qiu H, Lin C, Liu X, Teng Y, Li X, Zhang Y, Zhuang J, Chen J, Wen S. Permanent epicardial pacing in neonates and infants less than 1 year old: 12-year experience at a single center. Transl Pediatr 2022; 11:825-833. [PMID: 35800290 PMCID: PMC9253933 DOI: 10.21037/tp-21-525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Permanent epicardial pacing is the primary choice for neonates and infants with bradyarrhythmia. We reviewed mid-term outcomes after epicardial permanent pacemaker (EPPM) implantation in this age group. METHODS From Dec 1, 2008 to Dec 1, 2019, children who underwent EPPM implantation within the first year of life were included in our study. Patients were followed up for as long as 12 years, until Jun 11, 2021, for all-cause mortality and pacemaker reoperation. Kaplan-Meier and log-rank tests were used for analysis. RESULTS Of 31 consecutive patients [18 boys (58.1%) and 2 neonates (6.5%)] included in this study, 30 (96.8%) were discharged alive and assessed at a median follow-up of 3.9 years [interquartile range (IQR) 4.7]. The median age and weight of the patients were 156 days (IQR 217) and 5.3 kg (IQR 3.5), respectively, at the time of their operation. Twenty-five (80.6%) patients had congenital heart disease, and the main indication for pacing was postoperative atrioventricular block (AVB) in 21 (67.7%) patients. During follow-up, 3 (9.7%) patients died and there were a total of 9 pacing lead failures in 7 (22.6%) patients. The median longevity of leads (unipolar steroid-eluting) was 2.9 years (IQR 3.6). Freedom from lead reoperation was 90.3%, 72.0%, 65.5% and 49.1% at 1, 3, 5, and 8 years, respectively. The median longevity of the pacing generators was 3.3 years (IQR 2.8). Freedom from generator reoperation was 90.3%, 75.6%, 52.4% and 43.6% at 1, 3, 5 and 6 years, respectively. CONCLUSIONS The mid-term outcome of EPPM implantation in neonates and infants was acceptable. Neonates and infants with EPPM implants face the risk of repeated reoperations and all-cause death. A patient's prognosis can depend on regular follow-up, type of pacing lead and the presence of congenital heart malformations, especially complex congenital heart disease.
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Affiliation(s)
- Junfei Zhao
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liming Lei
- Department of Cardiac Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zeyang Yao
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tian Liu
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Canhui Lin
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaobing Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yun Teng
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaohua Li
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Zhang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Choi YS, Jeong H, Yin RT, Avila R, Pfenniger A, Yoo J, Lee JY, Tzavelis A, Lee YJ, Chen SW, Knight HS, Kim S, Ahn HY, Wickerson G, Vázquez-Guardado A, Higbee-Dempsey E, Russo BA, Napolitano MA, Holleran TJ, Razzak LA, Miniovich AN, Lee G, Geist B, Kim B, Han S, Brennan JA, Aras K, Kwak SS, Kim J, Waters EA, Yang X, Burrell A, Chun KS, Liu C, Wu C, Rwei AY, Spann AN, Banks A, Johnson D, Zhang ZJ, Haney CR, Jin SH, Sahakian AV, Huang Y, Trachiotis GD, Knight BP, Arora RK, Efimov IR, Rogers JA. A transient, closed-loop network of wireless, body-integrated devices for autonomous electrotherapy. Science 2022; 376:1006-1012. [PMID: 35617386 PMCID: PMC9282941 DOI: 10.1126/science.abm1703] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Temporary postoperative cardiac pacing requires devices with percutaneous leads and external wired power and control systems. This hardware introduces risks for infection, limitations on patient mobility, and requirements for surgical extraction procedures. Bioresorbable pacemakers mitigate some of these disadvantages, but they demand pairing with external, wired systems and secondary mechanisms for control. We present a transient closed-loop system that combines a time-synchronized, wireless network of skin-integrated devices with an advanced bioresorbable pacemaker to control cardiac rhythms, track cardiopulmonary status, provide multihaptic feedback, and enable transient operation with minimal patient burden. The result provides a range of autonomous, rate-adaptive cardiac pacing capabilities, as demonstrated in rat, canine, and human heart studies. This work establishes an engineering framework for closed-loop temporary electrotherapy using wirelessly linked, body-integrated bioelectronic devices.
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Affiliation(s)
- Yeon Sik Choi
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Precision Biology Research Center, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Hyoyoung Jeong
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Rose T. Yin
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Anna Pfenniger
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Jaeyoung Yoo
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Sibel Health, Niles, IL, 60714, USA
| | - Andreas Tzavelis
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Medical Scientist Training Program, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Young Joong Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Sheena W. Chen
- Department of General Surgery, The George Washington University, Washington, DC 20052, USA
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Helen S. Knight
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Seungyeob Kim
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Electronic Engineering, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, 406-772, Republic of Korea
| | - Hak-Young Ahn
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Precision Biology Research Center, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Grace Wickerson
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Abraham Vázquez-Guardado
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | | | - Bender A. Russo
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Michael A. Napolitano
- Department of General Surgery, The George Washington University, Washington, DC 20052, USA
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Timothy J. Holleran
- Department of General Surgery, The George Washington University, Washington, DC 20052, USA
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Leen Abdul Razzak
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Alana N. Miniovich
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Geumbee Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Beth Geist
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | | | - Shuling Han
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jaclyn A. Brennan
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Kedar Aras
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Sung Soo Kwak
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Current Address: Center for Bionics of Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 02792, Korea
| | - Joohee Kim
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Emily Alexandria Waters
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL 60208, USA
| | - Xiangxing Yang
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Tx, 78712, USA
| | - Amy Burrell
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Keum San Chun
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Tx, 78712, USA
| | - Claire Liu
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Changsheng Wu
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Alina Y. Rwei
- Department of Chemical Engineering, Delft University of Technology, Van der Maasweg 9, 2629 HZ Delft, The Netherlands
| | - Alisha N. Spann
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL 60208, USA
| | - Anthony Banks
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - David Johnson
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Zheng Jenny Zhang
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Chad R. Haney
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL 60208, USA
| | - Sung Hun Jin
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Electronic Engineering, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon, 406-772, Republic of Korea
| | - Alan Varteres Sahakian
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Yonggang Huang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Gregory D. Trachiotis
- Department of Cardiothoracic Surgery, Veteran Affairs Medical Center, Washington, DC 20422, USA
| | - Bradley P. Knight
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Rishi K. Arora
- Feinberg School of Medicine, Cardiology, Northwestern University, Chicago, IL 60611, USA
| | - Igor R. Efimov
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - John A. Rogers
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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7
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Prevention of the foreign body response to implantable medical devices by inflammasome inhibition. Proc Natl Acad Sci U S A 2022; 119:e2115857119. [PMID: 35298334 PMCID: PMC8944905 DOI: 10.1073/pnas.2115857119] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
SignificanceImplantable electronic medical devices (IEMDs) are used for some clinical applications, representing an exciting prospect for the transformative treatment of intractable conditions such Parkinson's disease, deafness, and paralysis. The use of IEMDs is limited at the moment because, over time, a foreign body reaction (FBR) develops at the device-neural interface such that ultimately the IEMD fails and needs to be removed. Here, we show that macrophage nucleotide-binding oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome activity drives the FBR in a nerve injury model yet integration of an NLRP3 inhibitor into the device prevents FBR while allowing full healing of damaged neural tissue to occur.
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8
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Buja LM, Schoen FJ. The pathology of cardiovascular interventions and devices for coronary artery disease, vascular disease, heart failure, and arrhythmias. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Yang Q, Wei T, Yin RT, Wu M, Xu Y, Koo J, Choi YS, Xie Z, Chen SW, Kandela I, Yao S, Deng Y, Avila R, Liu TL, Bai W, Yang Y, Han M, Zhang Q, Haney CR, Benjamin Lee K, Aras K, Wang T, Seo MH, Luan H, Lee SM, Brikha A, Ghoreishi-Haack N, Tran L, Stepien I, Aird F, Waters EA, Yu X, Banks A, Trachiotis GD, Torkelson JM, Huang Y, Kozorovitskiy Y, Efimov IR, Rogers JA. Photocurable bioresorbable adhesives as functional interfaces between flexible bioelectronic devices and soft biological tissues. NATURE MATERIALS 2021; 20:1559-1570. [PMID: 34326506 PMCID: PMC8551016 DOI: 10.1038/s41563-021-01051-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2021] [Indexed: 05/07/2023]
Abstract
Flexible electronic/optoelectronic systems that can intimately integrate onto the surfaces of vital organ systems have the potential to offer revolutionary diagnostic and therapeutic capabilities relevant to a wide spectrum of diseases and disorders. The critical interfaces between such technologies and living tissues must provide soft mechanical coupling and efficient optical/electrical/chemical exchange. Here, we introduce a functional adhesive bioelectronic-tissue interface material, in the forms of mechanically compliant, electrically conductive, and optically transparent encapsulating coatings, interfacial layers or supporting matrices. These materials strongly bond both to the surfaces of the devices and to those of different internal organs, with stable adhesion for several days to months, in chemistries that can be tailored to bioresorb at controlled rates. Experimental demonstrations in live animal models include device applications that range from battery-free optoelectronic systems for deep-brain optogenetics and subdermal phototherapy to wireless millimetre-scale pacemakers and flexible multielectrode epicardial arrays. These advances have immediate applicability across nearly all types of bioelectronic/optoelectronic system currently used in animal model studies, and they also have the potential for future treatment of life-threatening diseases and disorders in humans.
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Affiliation(s)
- Quansan Yang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Tong Wei
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL, USA
| | - Rose T Yin
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Mingzheng Wu
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
| | - Yameng Xu
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
- The Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Jahyun Koo
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
| | - Yeon Sik Choi
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian University of Technology, Dalian, China
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
- Ningbo Institute of Dalian University of Technology, Ningbo, China
| | - Sheena W Chen
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Irawati Kandela
- Developmental Therapeutics Core, Northwestern University, Evanston, IL, USA
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Shenglian Yao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, China
| | - Yujun Deng
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
- State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Tzu-Li Liu
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Wubin Bai
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yiyuan Yang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Mengdi Han
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Qihui Zhang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Chad R Haney
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - K Benjamin Lee
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - Kedar Aras
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Tong Wang
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL, USA
| | - Min-Ho Seo
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
- School of Biomedical Convergence Engineering, College of Information & Biomedical Engineering, Pusan National University, Pusan, Republic of Korea
| | - Haiwen Luan
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - Seung Min Lee
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Anlil Brikha
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, USA
| | | | - Lori Tran
- Developmental Therapeutics Core, Northwestern University, Evanston, IL, USA
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Iwona Stepien
- Developmental Therapeutics Core, Northwestern University, Evanston, IL, USA
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Fraser Aird
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA
| | - Emily A Waters
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA
- Center for Advanced Molecular Imaging, Northwestern University, Evanston, IL, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Xinge Yu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China
| | - Anthony Banks
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Gregory D Trachiotis
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
- DC Veterans Affairs Medical Center, The George Washington University, Washington, DC, USA
| | - John M Torkelson
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
| | - Yonggang Huang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
- Departments of Civil and Environmental Engineering, Northwestern University, Evanston, IL, USA
| | - Yevgenia Kozorovitskiy
- Department of Neurobiology, Northwestern University, Evanston, IL, USA.
- Chemistry Life Processes Institute, Northwestern University, Evanston, IL, USA.
| | - Igor R Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA.
| | - John A Rogers
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL, USA.
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA.
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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10
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Li J, Wang X. Materials Perspectives for Self-Powered Cardiac Implantable Electronic Devices toward Clinical Translation. ACCOUNTS OF MATERIALS RESEARCH 2021; 2:739-750. [PMID: 35386361 PMCID: PMC8979373 DOI: 10.1021/accountsmr.1c00078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Represented by pacemakers, implantable electronic devices (CIEDs) are playing a vital life-saving role in modern society. Although the current CIEDs are evolving quickly in terms of performance, safety, and miniaturization, the bulky and rigid battery creates the largest hurdle toward further development of a soft system that can be attached and conform to tissues without causing undesirable physiologic changes. Over 50% of patients with pacemakers require additional surgery procedures to replace a drained battery. Abrupt battery malfunction and failure contributes up to 2.4% of implanted leadless pacemakers. The battery also has risks of lethal interference with diagnostic magnetic resonance imaging (MRI). Applying the implantable nanogenerators (i-NGs) technology to CIEDs is regarded as a promising solution to the battery challenge and enables self-powering capability. I-NGs based on the principle of either triboelectricity (TENG) or piezoelectricity (PENG) can convert biomechanical energy into electricity effectively. Meanwhile, a complete heartbeat cycle provides a biomechanical energy of ~0.7 J or an average power of 0.93 W, which is sufficient for the operation of CIEDs considering the power consumption of 5-10 μW for a pacemaker and 10-100 μW for a cardiac defibrillator. It is therefore practical to leverage the effective, soft, flexible, lightweight, and biocompatible i-NGs to eliminate the bulky battery component in CIEDs and achieve self-sustainable operation. In this rapidly evolving interdisciplinary field, materials innovation acts as a cornerstone that frames the technology development. Here we bring a few critical perspectives regarding materials design and engineering, which are essential in leading the NG-powered CIEDs toward clinical translations. This Account starts with a brief introduction of the cardiac electrophysiology, as well as its short history to interface the state-of-the-art cardiac NG technologies. Three key components of NG-powered CIEDs are discussed in detail, including the NG device itself, the packaging material, and the stimulation electrodes. Cardiac NG is the essential component that converts heartbeat energy into electricity. It demands high-performance electromechanical coupling materials with long-term dynamic stability. The packaging material is critical to ensure a long-term stable operation of the device on a beating heart. Given the unique operation environment, a few criteria need to be considered in its development, including flexibility, biocompatibility, antifouling, hemocompatibility, and bioadhesion. The stimulation electrodes are the only material interfacing the heart tissue electrically. They should provide capacitive charge injection and mimic the soft and wet intrinsic tissues for the sake of stable biointerfaces. Driven by the rapid materials and device advancement, we envision that the evolution of NG-based CIEDs will quickly move from epicardiac to intracardiac, from single-function to multifunction, and with a minimal-invasive implantation procedure. This trend of development will open many research opportunities in emerging materials science and engineering, which will eventually lead the NG technology to a prevailing strategy for powering future CIEDs.
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Affiliation(s)
- Jun Li
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53706, United States
| | - Xudong Wang
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53706, United States
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11
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Degache A, Poulletier de Gannes F, Garenne A, Renom R, Percherancier Y, Lagroye I, Bernus O, Lewis N. In vitrodifferentiation of human cardiac fibroblasts into myofibroblasts: characterization using electrical impedance. Biomed Phys Eng Express 2021; 8. [PMID: 34243179 DOI: 10.1088/2057-1976/ac12e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 11/12/2022]
Abstract
Cardiac arrhythmias represent about 50% of the cardiovascular diseases which are the first cause of mortality in the world. Implantable medical devices play a major role for treating these arrhythmias. Nevertheless the leads induce an unwanted biological phenomenon called fibrosis. This phenomenon begins at a cellular level and is effective at a macroscopic scale causing tissue remodelling with a local modification of the active cardiac tissue. Fibrosis mechanism is complex but at the cellular level, it mainly consists in cardiac fibroblasts activation and differentiation into myofibroblasts. We developed a simplifiedin vitromodel of cardiac fibrosis, with human cardiac fibroblasts whom differentiation into myofibroblasts was promoted with TGF-β1. Our study addresses an unreported impedance-based method for real-time monitoring ofin vitrocardiac fibrosis. The objective was to study whether the differentiation of cardiac fibroblasts in myofibroblasts had a specific signature on the cell index, an impedance-based feature measured by the xCELLigence system. Primary human cardiac fibroblasts were cultured along 6 days, with or without laminin coating, to study the role of this adhesion protein in cultures long-term maintenance. The cultures were characterized in the presence or absence of TGF-β1 and we obtained a significant cell index signature specific to the human cardiac fibroblasts differentiation.
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Affiliation(s)
- Amelie Degache
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Florence Poulletier de Gannes
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - André Garenne
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Rémy Renom
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Yann Percherancier
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Isabelle Lagroye
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
| | - Olivier Bernus
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, U1045, University of Bordeaux, Avenue du haut leveque, Pessac, Aquitaine, 33600, FRANCE
| | - Noëlle Lewis
- IMS Laboratory, CNRS UMR 5218, University of Bordeaux College of Science and Technology, 351 cours de la liberation, Talence, Aquitaine, 33400, FRANCE
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12
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Carnicer-Lombarte A, Chen ST, Malliaras GG, Barone DG. Foreign Body Reaction to Implanted Biomaterials and Its Impact in Nerve Neuroprosthetics. Front Bioeng Biotechnol 2021; 9:622524. [PMID: 33937212 PMCID: PMC8081831 DOI: 10.3389/fbioe.2021.622524] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/19/2021] [Indexed: 12/04/2022] Open
Abstract
The implantation of any foreign material into the body leads to the development of an inflammatory and fibrotic process-the foreign body reaction (FBR). Upon implantation into a tissue, cells of the immune system become attracted to the foreign material and attempt to degrade it. If this degradation fails, fibroblasts envelop the material and form a physical barrier to isolate it from the rest of the body. Long-term implantation of medical devices faces a great challenge presented by FBR, as the cellular response disrupts the interface between implant and its target tissue. This is particularly true for nerve neuroprosthetic implants-devices implanted into nerves to address conditions such as sensory loss, muscle paralysis, chronic pain, and epilepsy. Nerve neuroprosthetics rely on tight interfacing between nerve tissue and electrodes to detect the tiny electrical signals carried by axons, and/or electrically stimulate small subsets of axons within a nerve. Moreover, as advances in microfabrication drive the field to increasingly miniaturized nerve implants, the need for a stable, intimate implant-tissue interface is likely to quickly become a limiting factor for the development of new neuroprosthetic implant technologies. Here, we provide an overview of the material-cell interactions leading to the development of FBR. We review current nerve neuroprosthetic technologies (cuff, penetrating, and regenerative interfaces) and how long-term function of these is limited by FBR. Finally, we discuss how material properties (such as stiffness and size), pharmacological therapies, or use of biodegradable materials may be exploited to minimize FBR to nerve neuroprosthetic implants and improve their long-term stability.
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Affiliation(s)
- Alejandro Carnicer-Lombarte
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Shao-Tuan Chen
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - George G. Malliaras
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Damiano G. Barone
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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13
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An Z, Wu J, Li SH, Chen S, Lu FL, Xu ZY, Sung HW, Li RK. Injectable conductive hydrogel can reduce pacing threshold and enhance efficacy of cardiac pacemaker. Am J Cancer Res 2021; 11:3948-3960. [PMID: 33664872 PMCID: PMC7914366 DOI: 10.7150/thno.54959] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Pacemaker implantation is currently used in patients with symptomatic bradycardia. Since a pacemaker is a lifetime therapeutic device, its energy consumption contributes to battery exhaustion, along with its voltage stimulation resulting in local fibrosis and greater resistance, which are all detrimental to patients. The possible resolution for those clinical issues is an injection of a conductive hydrogel, poly-3-amino-4-methoxybenzoic acid-gelatin (PAMB-G), to reduce the myocardial threshold voltage for pacemaker stimulation. Methods: PAMB-G is synthesized by covalently linking PAMB to gelatin, and its conductivity is measured using two-point resistivity. Rat hearts are injected with gelatin or PAMB-G, and pacing threshold is evaluated using electrocardiogram and cardiac optical mapping. Results: PAMB-G conductivity is 13 times greater than in gelatin. The ex vivo model shows that PAMB-G significantly enhances cardiac tissue stimulation. Injection of PAMB-G into the stimulating electrode location at the myocardium has a 4 times greater reduction of pacing threshold voltage, compared with electrode-only or gelatin-injected tissues. Multi-electrode array mapping reveals that the cardiac conduction velocity of PAMB-G group is significantly faster than the non- or gelatin-injection groups. PAMB-G also reduces pacing threshold voltage in an adenosine-induced atrial-ventricular block rat model. Conclusion: PAMB-G hydrogel reduces cardiac pacing threshold voltage, which is able to enhance pacemaker efficacy.
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14
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The Cardiac Pacemaker Clinic: Memories From a Bygone Era. Heart Lung Circ 2020; 30:216-224. [PMID: 33032899 DOI: 10.1016/j.hlc.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022]
Abstract
In 1963, soon after the first ventricular pacemakers were implanted at the Royal Melbourne Hospital, attempts were made to identify impending pacing failure, thus preventing sudden death in these very vulnerable patients. By 1970, patient numbers had increased, a formal regular pacemaker clinic was established, and guidelines and protocols developed. The clinic was staffed by a physician, a biomedical engineer and cardiac technicians. The unipolar, asynchronous, non-programmable pulse generators were powered by mercuric oxide/zinc batteries and implanted in the abdomen, using either transvenous or epimyocardial leads. Although, pulse generators were electively replaced at 3 years, most had already been replaced because of power source depletion, electronic failure or lead issues. Testing in all patients involved an electrocardiographic rhythm strip and electronic analysis of the stimulus artefact using a calibrated high-speed storage oscilloscope. Results were compared to previous studies and significant changes were interpreted as impending power source depletion. As a result of this testing, 97% of cases of impending power source depletion were detected prior to failure. These findings allowed testing each 4 months and for pulse generator life to be extended beyond three years. With ventricular triggered pulse generators, new testing procedures were designed. With time, visiting regional centres and clinical evaluation of new products became important functions of the clinic.
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15
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He S, Wu J, Li SH, Wang L, Sun Y, Xie J, Ramnath D, Weisel RD, Yau TM, Sung HW, Li RK. The conductive function of biopolymer corrects myocardial scar conduction blockage and resynchronizes contraction to prevent heart failure. Biomaterials 2020; 258:120285. [PMID: 32781327 DOI: 10.1016/j.biomaterials.2020.120285] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/24/2020] [Accepted: 08/01/2020] [Indexed: 11/28/2022]
Abstract
Myocardial fibrosis, resulting from ischemic injury, increases tissue resistivity in the infarct area, which impedes heart synchronous electrical propagation. The uneven conduction between myocardium and fibrotic tissue leads to dys-synchronous contraction, which progresses towards ventricular dysfunction. We synthesized a conductive poly-pyrrole-chitosan hydrogel (PPY-CHI), and investigated its capabilities in improving electrical propagation in fibrotic tissue, as well as resynchronizing cardiac contraction to preserve cardiac function. In an in vitro fibrotic scar model, conductivity increased in proportion to the amount of PPY-CHI hydrogel added. To elucidate the mechanism of interaction between myocardial ionic changes and electrical current, an equivalent circuit model was used, which showed that PPY-CHI resistance was 10 times lower, and latency time 5 times shorter, compared to controls. Using a rat myocardial infarction (MI) model, PPY-CHI was injected into fibrotic tissue 7 days post MI. There, PPY-CHI reduced tissue resistance by 30%, improved electrical conduction across the fibrotic scar by 33%, enhanced field potential amplitudes by 2 times, and resynchronized cardiac contraction. PPY-CHI hydrogel also preserved cardiac function at 3 months, and reduced susceptibility to arrhythmia by 30% post-MI. These data demonstrated that the conductive PPY-CHI hydrogel reduced fibrotic scar resistivity, and enhanced electrical conduction, to synchronize cardiac contraction.
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Affiliation(s)
- Sheng He
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Wu
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shu-Hong Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Li Wang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Yu Sun
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Jun Xie
- Department of Biochemistry and Molecular Biology, Shanxi Key Laboratory of Birth Defect and Cell Regeneration, Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, China
| | - Daniel Ramnath
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard D Weisel
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Terrence M Yau
- Division of Cardiovascular Surgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Hsing-Wen Sung
- Department of Chemical Engineering and Frontier Research Center on Fundamental and Applied Sciences of Matters, National Tsing Hua University, Hsinchu, Taiwan, ROC
| | - Ren-Ke Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.
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16
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Jiang M, Wasserlauf J, Knight BP, Verma N. Increased capture threshold in permanent His‐bundle pacing associated with flecainide. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:360-363. [DOI: 10.1111/pace.13879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/06/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Jiang
- Division of Cardiology/ElectrophysiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago Illinois
| | - Jeremiah Wasserlauf
- Division of Cardiology/ElectrophysiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago Illinois
| | - Bradley P Knight
- Division of Cardiology/ElectrophysiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago Illinois
| | - Nishant Verma
- Division of Cardiology/ElectrophysiologyDepartment of MedicineNorthwestern University Feinberg School of Medicine Chicago Illinois
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17
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Abstract
The theory of bioelectrodes describes the rules governing the passage of electrical charge between electrodes and electrolytes. In this review, we explain the basis of bioelectrodes with focus on clinical electrophysiology. The central concept is the double-layer capacitance that forms in the interface between the electrode and tissue. This phenomenon controls charge transfer between electrodes and tissues and contributes to detrimental effects such as electrode polarization and motion artifacts. Many methods critical to the practice of electrophysiology, including fractally coated pacemaker leads, biphasic stimuli, signal filtering, and the use of nonpolarizable electrodes, are devised to mitigate these problems. Our goal is to provide a robust and intuitive background on these topics for practicing electrophysiologists to help them better understand how catheters and leads work and to assist them with optimizing and troubleshooting electrophysiology systems.
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Affiliation(s)
- Shahriar Iravanian
- Division of Cardiology, Section of Cardiac Electrophysiology, School of Medicine, Emory University, Atlanta, Georgia
| | - Jonathan J Langberg
- Division of Cardiology, Section of Cardiac Electrophysiology, School of Medicine, Emory University, Atlanta, Georgia.
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18
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Cardiac pacemakers: a basic review of the history and current technology. J Vet Cardiol 2019; 22:40-50. [PMID: 30792165 DOI: 10.1016/j.jvc.2019.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
In the 60 years since the first human implant of a cardiac pacemaker, tremendous improvements have been made to devices themselves as well as the lead systems. Improvement in battery materials has allowed for production of smaller devices with greater longevity and a vast array of technologies allowing for communication between the device and the operator. Lead wires, typically to as the weakest part of the pacing system, have also seen a metamorphosis as improvements in conductor materials and hybrid insulation have been shown to improve reliability. With the recent development of leadless pacing systems, the downfalls of implantable leads can be avoided. These improvements have allowed a more widespread use of cardiac pacing in veterinary applications since the first reported canine implant in 1967.
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19
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Mechanistic implication of decreased plasma atrial natriuretic peptide level for transient rise in the atrial capture threshold early after ICD or CRT-D implantation. J Interv Card Electrophysiol 2018; 53:131-140. [PMID: 30019272 DOI: 10.1007/s10840-018-0409-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Despite the use of steroid-eluting leads, a transient but not persistent rise in the atrial/ventricular capture threshold (TRACT/TRVCT) can occur early after pacemaker implantation in patients with sick sinus syndrome. This study aimed to assess the prevalence, predictors, and mechanisms of TRACT/TRVCT in patients with heart failure undergoing implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) implantation. METHOD One hundred twenty consecutive patients underwent ICD (N = 70) or CRT (N = 50) implantation. Capture threshold was measured at implantation, 7-day, 1-month, and 6-month post-implantation. TRACT/TRVCT was defined as a threshold rise at 7 days by more than twice the height of the threshold at implantation, with full recovery during follow-up. Atrial and brain natriuretic peptide (ANP and BNP) levels were measured before implantation. RESULTS TRACT and TRVCT were observed in 13 (11%) and 10 (8%) patients, respectively. Patients with TRACT had lower ANP level (median 72 [42-105] vs. 99 [49-198] pg/mL, P = 0.06), lower ANP/BNP ratio (0.29 [0.20-0.36] vs. 0.50 [0.33-0.70], P < 0.01), lower atrial sensing amplitude (2.0 ± 0.8 vs. 2.7 ± 1.3 mV, P = 0.02), and lower left ventricular ejection fraction (32 ± 12 vs. 40 ± 14%, P = 0.04) than those without TRACT. TRACT recovered within 1 month, whereas TRVCT recovered within 6 months. In multivariable analysis, ANP/BNP ratio was the only independent predictor of TRACT (OR, 0.018; 95% CI, 0.001-0.734; P = 0.034). CONCLUSIONS Atrial degenerative change characterized by lower ANP/BNP ratio was associated with the occurrence of TRACT in patients with heart failure. TRVCT could also occur, but it required a longer recovery time than TRACT.
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Lin AC, Biffi M, Exner DV, Johnson WB, Gras D, Hussin A, Singh B, Yang Z, Hine D, Li S, Crossley GH. Long-term electrical performance of Attain Performa quadripolar left ventricular leads with all steroid-eluting electrodes: Results from a large worldwide clinical trial. Pacing Clin Electrophysiol 2018; 41:920-926. [PMID: 29808920 DOI: 10.1111/pace.13389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 03/15/2018] [Accepted: 03/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Steroid-eluting (SE) electrodes suppress local inflammation and lower pacing capture thresholds (PCT); however, their effectiveness on quadripolar left ventricular (LV) leads in the cardiac vein is not fully studied. We evaluated the effectiveness of SE on all four LV pacing electrodes in human subjects enrolled in the Medtronic Attain® Performa™ quadripolar LV lead study. METHODS A total of 1,097 subjects were included in this evaluation. At each follow-up visit (1, 3, 6, and 12 months), LV PCT and pacing impedance were measured using either manual or automated testing methods. Summary statistics for PCT and impedance values were obtained for implant and each scheduled follow-up visit for all lead models. RESULTS Average extended bipolar (LV electrode to right ventricular Coil) PCTs for the four LV SE pacing electrodes (LV1, LV2, LV3, and LV4) on the three shapes of the quadripolar LV leads were 1.06 ± 0.97 V, 1.38 ± 1.26 V, 1.51 ± 1.33 V, and 2.25 ± 1.63 V, respectively, at 0.5-ms pulse width. PCTs remained low and stable throughout the 12-month follow-up period. CONCLUSION This clinical trial demonstrated that SE on all LV pacing electrodes is associated with low and stable PCTs for all quadripolar LV lead electrodes, resulting in multiple viable vectors for LV pacing. The large number of available vectors facilitates basal pacing, avoidance of PNS, and potentially prolongs generator longevity due to lower PCTs.
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Affiliation(s)
- Albert C Lin
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mauro Biffi
- Insitute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Azlan Hussin
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - Balbir Singh
- Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | | | | | - Shelby Li
- Medtronic, plc, Mounds View, MN, USA
| | - George H Crossley
- Vanderbilt Heart and Vascular Institute, Vanderbilt University, Nashville, TN, USA
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21
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Varvarousis D, Goulas N, Polytarchou K, Psychari SN, Paravolidakis K, Konstantinidou A, Tsoukalas D, Vlad D, Bouki K, Kotsakis A. Biomarkers of Myocardial Injury and Inflammation after Permanent Pacemaker Implantation: The Lead Fixation Type Effect. J Atr Fibrillation 2018; 10:1798. [PMID: 29988295 DOI: 10.4022/jafib.1798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/19/2018] [Accepted: 02/14/2018] [Indexed: 11/10/2022]
Abstract
Background Permanent pacemaker implantation is accompanied by minor myocardial damage, indicated by elevated serum levels of cardiac biomarkers. Aim of this prospective study was to comparably investigate the lead fixation type effect on the extent of myocardial injury and inflammation following pacemaker implantation, and to assess the possible clinical implications. Methods Cardiac troponin I (cTnI) and C-reactive protein (CRP) were measured at baseline, 6 and 24h after implantation in 101 patients, categorized into the active and passive lead fixation group. Patients were followed up for clinical adverse events or abnormal pacing parameters at 24h, 7 and 30 days post-procedure. Results cTnI increased at 6h post-procedure (p<0.05) in 23.8% of patients, and returned to baseline after 24h. The passive group demonstrated significantly higher cTnI at 6h compared to the active group (p=0.006). CRP increased significantly at 6h, and maintained an upward trend after 24h (p<0.01) in both groups. The active group demonstrated significantly higher CRP at 6h compared to the passive group. We did not identify an association of positive biomarkers with adverse events. Conclusion cTnI and CRP can increase early after permanent pacemaker implantation, indicating mechanical myocardial injury and inflammation. The extent of these biomarkers elevation depends on the lead fixation type, and is not related to worse short-term prognosis.
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Affiliation(s)
- Dimitrios Varvarousis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Nikolaos Goulas
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Kali Polytarchou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Stavroula N Psychari
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Konstantinos Paravolidakis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Agapi Konstantinidou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Dionysios Tsoukalas
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Delia Vlad
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Konstantina Bouki
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
| | - Athanasios Kotsakis
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", D. Mantouvalou 3, 18454, Piraeus, Greece
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22
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Uehara Y, Yoshida K, Kimata A, Ogawa K, Abe D, Tsumagari Y, Tsuneoka H, Yui Y, Ito Y, Ebine M, Takeyasu N, Aonuma K, Nogami A. Underrecognized entity of the transient rise in the atrial capture threshold early after dual-chamber pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1396-1404. [PMID: 29139149 DOI: 10.1111/pace.13235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/05/2017] [Accepted: 10/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Steroid-eluting pacemaker leads suppress acute rises in pacing threshold by preventing inflammatory processes. However, we occasionally encounter not persistent but transient rise in the atrial capture threshold (TRACT) early after pacemaker implantation. We believe that this phenomenon is underrecognized in clinical practice and may potentially lead to unnecessary reintervention. We aimed to clarify the prevalence, predictors, and possible mechanisms of TRACT. METHODS AND RESULTS We reviewed clinical records from 239 consecutive patients who underwent dual-chamber pacemaker implantation for sick sinus syndrome (SSS) (N = 102) or atrioventricular block (AVB) (N = 137). Atrial capture threshold was measured at implantation and 7 days, 2 months, and 8 months postimplantation. TRACT was defined as a rise in the threshold at day 7 to ≥twice that at implantation, with an absolute value ≥1.0 V/0.4 ms, and full recovery by 8 months into follow-up. TRACT was observed in 15 patients (6%), of whom13 (87%) suffered from SSS but not AVB. Patients with TRACT had greater body mass index (BMI) (25 ± 5 kg/m2 vs 23 ± 4 kg/m2 , P = 0.01), larger left atrium (42 ± 5 mm vs 38 ± 7 mm, P = 0.03), and were more likely to suffer from paroxysmal atrial fibrillation (60% vs 31%, P = 0.02) than those without TRACT. In multivariable logistic regression analysis, BMI and SSS were the independent predictors of TRACT (odds ratio [OR], 1.172; 95% confidence interval [CI], 1.019-1.349; P = 0.03 and OR, 11.53; 95% CI, 2.010-66.21; P = 0.006, respectively). CONCLUSIONS The distinct phenomenon of TRACT was not rare in clinical practice early after dual-chamber pacemaker implantation, and its occurrence was strongly associated with SSS.
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Affiliation(s)
- Yoshiko Uehara
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Kentaro Yoshida
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan.,Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Kimata
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kojiro Ogawa
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Daisuke Abe
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuaki Tsumagari
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Hidekazu Tsuneoka
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Yoshiaki Yui
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoko Ito
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mari Ebine
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Noriyuki Takeyasu
- Department of Cardiology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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24
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Caliskan E, Fischer F, Schoenrath F, Emmert MY, Maisano F, Falk V, Starck CT, Holubec T. Epicardial left ventricular leads via minimally invasive technique: a role of steroid eluting leads. J Cardiothorac Surg 2017; 12:95. [PMID: 29117867 PMCID: PMC5678761 DOI: 10.1186/s13019-017-0659-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022] Open
Abstract
Background We retrospectively assessed two types of sutureless screw-in left ventricular (LV) leads (steroid eluting vs. non-steroid eluting) in cardiac resynchronization therapy (CRT) implantation with regards to their electrical performance. Methods Between March 2008 and May 2014 an epicardial LV lead was implanted in 32 patients after failed transvenous LV lead placement using a left-sided lateral minithoracotomy or video-assisted thoracoscopy (mean age 64 ± 9 years). Patients were divided into two groups according to the type of implanted lead. Steroid eluting (SE) group: 21 patients (Myodex™ 1084 T; St. Jude Medical) and non-steroid eluting (NSE) group: 11 patients (MyoPore® 511,212; Greatbatch Medical). Results All epicardial leads could be placed successfully, without any intraoperative complications or mortality. With regard to the implanted lead following results were observed: sensing (mV): SE 8.8 ± 6.1 vs. NSE 10.1 ± 5.3 (p = 0.380); pacing threshold (V@0.5 ms): SE 1.0 ± 0.5 vs. NSE 0.9 ± 0.5 (p = 0.668); impedance (ohms): SE 687 ± 236 vs. NSE 790 ± 331 (p = 0.162). At the follow-up (2.6 ± 1.9 years) the following results were seen: sensing (mV): SE 8.7 ± 5.0 vs. NSE 11.2 ± 6.6 (p = 0.241), pacing threshold (V@0.5 ms): SE 1.4 ± 0.5 vs. NSE 1.0 ± 0.3 (p = 0.035), impedance (ohms): SE 381 ± 95 vs. NSE 434 ± 88 (p = 0.129). Conclusions Based on the results no strong differences have been found between the both types of epicardial LV leads (steroid eluting vs. non-steroid eluting) in CRT implantation in short- and midterm.
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Affiliation(s)
- Etem Caliskan
- Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florian Fischer
- Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Maximilian Y Emmert
- Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Tomas Holubec
- Clinic for Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, 61231, Bad Nauheim, Germany.
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25
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Transmural Placement of Endocardial Pacing Leads in Patients With Congenital Heart Disease. Ann Thorac Surg 2016; 101:2335-40. [DOI: 10.1016/j.athoracsur.2015.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/06/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022]
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26
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Feiner R, Engel L, Fleischer S, Malki M, Gal I, Shapira A, Shacham-Diamand Y, Dvir T. Engineered hybrid cardiac patches with multifunctional electronics for online monitoring and regulation of tissue function. NATURE MATERIALS 2016; 15:679-85. [PMID: 26974408 PMCID: PMC4900449 DOI: 10.1038/nmat4590] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 01/29/2016] [Indexed: 05/04/2023]
Abstract
In cardiac tissue engineering approaches to treat myocardial infarction, cardiac cells are seeded within three-dimensional porous scaffolds to create functional cardiac patches. However, current cardiac patches do not allow for online monitoring and reporting of engineered-tissue performance, and do not interfere to deliver signals for patch activation or to enable its integration with the host. Here, we report an engineered cardiac patch that integrates cardiac cells with flexible, freestanding electronics and a 3D nanocomposite scaffold. The patch exhibited robust electronic properties, enabling the recording of cellular electrical activities and the on-demand provision of electrical stimulation for synchronizing cell contraction. We also show that electroactive polymers containing biological factors can be deposited on designated electrodes to release drugs in the patch microenvironment on demand. We expect that the integration of complex electronics within cardiac patches will eventually provide therapeutic control and regulation of cardiac function.
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Affiliation(s)
- Ron Feiner
- The laboratory for tissue engineering and regenerative medicine, Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Science, Tel Aviv University, Tel Aviv 69978, Israel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Leeya Engel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Sharon Fleischer
- The laboratory for tissue engineering and regenerative medicine, Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Science, Tel Aviv University, Tel Aviv 69978, Israel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
| | - Maayan Malki
- The laboratory for tissue engineering and regenerative medicine, Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Science, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Idan Gal
- The laboratory for tissue engineering and regenerative medicine, Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Science, Tel Aviv University, Tel Aviv 69978, Israel
| | - Assaf Shapira
- The laboratory for tissue engineering and regenerative medicine, Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Science, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yosi Shacham-Diamand
- Department of Physical Electronics, Faculty of Engineering, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Tal Dvir
- The laboratory for tissue engineering and regenerative medicine, Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Science, Tel Aviv University, Tel Aviv 69978, Israel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Materials Science and Engineering, Tel Aviv University, Tel Aviv 69978, Israel
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Abstract
OBJECTIVE Medical implants made of non-biological materials provoke a chronic inflammatory response, resulting in the deposition of a collagenous scar tissue (ST) layer on their surface, that gradually thickens over time. This is a critical problem for neural interfaces. Scar build-up on electrodes results in a progressive decline in signal level because the scar tissue gradually separates axons away from the recording contacts. In regenerative sieves and microchannel electrodes, progressive scar deposition will constrict and may eventually choke off the sieve hole or channel lumen. Interface designs need to address this issue if they are to be fit for long term use. This study examines a novel method of inhibiting the formation and thickening of the fibrous scar. APPROACH Research to date has mainly focused on methods of preventing stimulation of the foreign body response by implant surface modification. In this paper a pharmacological approach using drug elution to suppress chronic inflammation is introduced. Microchannel implants made of silicone doped with the steroid drug dexamethasone were implanted in the rat sciatic nerve for periods of up to a year. Tissue from within the microchannels was compared to that from control devices that did not release any drug. MAIN RESULTS In the drug eluting implants the scar layer was significantly thinner at all timepoints, and unlike the controls it did not continue to thicken after 6 months. Control implants supported axon regeneration well initially, but axon counts fell rapidly at later timepoints as scar thickened. Axon counts in drug eluting devices were initially much lower, but increased rather than declined and by one year were significantly higher than in controls. SIGNIFICANCE Drug elution offers a potential long term solution to the problem of performance degradation due to scarring around neural implants.
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Affiliation(s)
- James J FitzGerald
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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28
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Buja L, Schoen F. The Pathology of Cardiovascular Interventions and Devices for Coronary Artery Disease, Vascular Disease, Heart Failure, and Arrhythmias. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00032-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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29
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YANG ZHONGPING, KIRCHHOF NICOLE, LI SHELBY, HINE DOUGLAS, MCVENES RICK. Effect of Steroid Elution on Electrical Performance and Tissue Responses in Quadripolar Left Ventricular Cardiac Vein Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:966-72. [DOI: 10.1111/pace.12624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 02/03/2023]
Affiliation(s)
- ZHONGPING YANG
- Cardiac Rhythm Heart Failure Research & Technology Medtronic PLC Mounds View Minnesota
| | - NICOLE KIRCHHOF
- Physiological Research Laboratories Medtronic PLC Minneapolis Minnesota
| | - SHELBY LI
- Cardiac Rhythm Heart Failure Research & Technology Medtronic PLC Mounds View Minnesota
| | - DOUGLAS HINE
- Cardiac Rhythm Heart Failure Research & Technology Medtronic PLC Mounds View Minnesota
| | - RICK MCVENES
- Cardiac Rhythm Heart Failure Research & Technology Medtronic PLC Mounds View Minnesota
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30
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Pang BJ, Barold SS, Mond HG. Injury to the coronary arteries and related structures by implantation of cardiac implantable electronic devices. Europace 2015; 17:524-9. [DOI: 10.1093/europace/euu345] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/06/2014] [Indexed: 01/19/2023] Open
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31
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MOND HARRYG, FREITAG GARY. The Cardiac Implantable Electronic Device Power Source: Evolution and Revolution. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1728-45. [DOI: 10.1111/pace.12526] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/14/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Affiliation(s)
- HARRY G. MOND
- Department of Cardiology; the Royal Melbourne Hospital; Victoria Australia
- Department of Medicine; the University of Melbourne; Melbourne; Australia
| | - GARY FREITAG
- Product Development Engineering; Greatbatch Inc; Clarence New York
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