The long-term outcomes of cardiac implantable electronic devices implanted via the femoral route

Question-based development of high-risk medical devices: A proposal for a structured design and review process

INTRODUCTION

The recent introduction of the European Medical Device Regulation poses stricter legislation for manufacturers developing medical devices in the EU. Many devices have been placed into a higher risk category, thus requiring more data before market approval, and a much larger focus has been placed on safety. For implantable and Class III devices, the highest risk class, clinical evidence is a necessity. However, the requirements of clinical study design and developmental outcomes are only described in general terms due to the diversity of devices.

METHODS

A structured approach to determining the requirements for the clinical development of high-risk medical devices is introduced, utilizing the question-based development framework, which is already used for pharmaceutical drug development. An example of a novel implantable device for haemodialysis demonstrates how to set up a relevant target product profile defining the device requirements and criteria. The framework can be used in the medical device design phase to define specific questions to be answered during the ensuing clinical development, based upon five general questions, specified by the question-based framework.

RESULTS

The result is a clear and evaluable overview of requirements and methodologies to verify and track these requirements in the clinical development phase. Development organizations will be guided to the optimal route, also to abandon projects destined for failure early on to minimize development risks.

CONCLUSION

The framework could facilitate communication with funding agencies, regulators and clinicians, while highlighting remaining 'known unknowns' that require answering in the post-market phase after sufficient benefit is established relative to the risks.

Optimizing Cardiac Wireless Implant Communication: A Feasibility Study on Selecting the Frequency and Matching Medium

Cardiac wireless implantable medical devices (CWIMD) have brought a paradigm shift in monitoring and treating various cardiac conditions, including heart failure, arrhythmias, and hypertension. One of the key elements in CWIMD is the implant antenna which uses radio frequency (RF) technology to wirelessly communicate and transmit data to external devices. However, wireless communication with a deeply implanted antenna using RF can be challenging due to the significant loss of electromagnetic (EM) signal at the air-skin interface, and second, due to the propagation and reflection of EM waves from different tissue boundaries. The air-skin interface loss of the EM wave is pronounced due to the absence of a matching medium. This paper investigates the EM propagation losses in the human body and presents a choice of optimal frequency for the design of the cardiac implant antenna and the dielectric properties of the matching medium. First, the dielectric properties of all tissues present in the human thorax including skin, fat, muscle, cartilage, and heart are analyzed as a function of frequency to study the EM wave absorption at different frequencies. Second, the penetration of EM waves inside the biological tissues is analyzed as a function of frequency. Third, a transmission line (TL) formalism approach is adopted to examine the optimal frequency band for designing a cardiac implant antenna and the matching medium for the air-skin interface. Finally, experimental validation is performed at two ISM frequencies, 433 MHz and 915 MHz, selected from the optimal frequency band (0.4-1.5 GHz) suggested by our analytical investigation. For experimental validation, two off-the-shelf flexible dipole antennas operating at selected ISM frequencies were used. The numerical and experimental findings suggested that for the specific application of a cardiac implant with a penetration depth of 7-17 cm, the most effective frequency range for operation is within 0.4-1.5 GHz. The findings based on the dielectric properties of thorax tissues, the penetration depth of EM waves, and the optimal frequency band have provided valuable information on developing and optimizing CWIMDs for cardiac care applications.