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Ausra J, Madrid M, Yin RT, Hanna J, Arnott S, Brennan JA, Peralta R, Clausen D, Bakall JA, Efimov IR, Gutruf P. Wireless, fully implantable cardiac stimulation and recording with on-device computation for closed-loop pacing and defibrillation. SCIENCE ADVANCES 2022; 8:eabq7469. [PMID: 36288311 PMCID: PMC9604544 DOI: 10.1126/sciadv.abq7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Monitoring and control of cardiac function are critical for investigation of cardiovascular pathophysiology and developing life-saving therapies. However, chronic stimulation of the heart in freely moving small animal subjects, which offer a variety of genotypes and phenotypes, is currently difficult. Specifically, real-time control of cardiac function with high spatial and temporal resolution is currently not possible. Here, we introduce a wireless battery-free device with on-board computation for real-time cardiac control with multisite stimulation enabling optogenetic modulation of the entire rodent heart. Seamless integration of the biointerface with the heart is enabled by machine learning-guided design of ultrathin arrays. Long-term pacing, recording, and on-board computation are demonstrated in freely moving animals. This device class enables new heart failure models and offers a platform to test real-time therapeutic paradigms over chronic time scales by providing means to control cardiac function continuously over the lifetime of the subject.
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Affiliation(s)
- Jokubas Ausra
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Micah Madrid
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Rose T. Yin
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Jessica Hanna
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Suzanne Arnott
- Department of Surgery, The George Washington University, Washington, DC 20037, USA
| | - Jaclyn A. Brennan
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
| | - Roberto Peralta
- Department of Aerospace and Mechanical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - David Clausen
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Jakob A. Bakall
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
| | - Igor R. Efimov
- Department of Biomedical Engineering, The George Washington University, Washington, DC 20052, USA
- Department of Biomedical Engineering, Northwestern University, Chicago IL 60611, USA
- Department of Medicine (Cardiology), Northwestern University, Chicago, IL 60611, USA
| | - Philipp Gutruf
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ 85721, USA
- Department of Electrical and Computer Engineering, The University of Arizona, Tucson, AZ 85721, USA
- Bio5 Institute, The University of Arizona, Tucson, AZ 85721, USA
- Neuroscience Graduate Interdisciplinary Program (GIDP), The University of Arizona, Tucson, AZ 85721, USA
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Antoniou CK, Xydis P, Konstantinou K, Magkas N, Manolakou P, Dilaveris P, Chrysohoou C, Gatzoulis KA, Tsioufis C. Multipoint left ventricular pacing as an addition to cardiac resynchronization therapy: a bridge to the holy grail? AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:429-440. [PMID: 34548940 PMCID: PMC8449203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Cardiac resynchronization therapy (CRT) constitutes a cornerstone to the treatment of advanced dyssynchronous heart failure (DyssHF); moreover it represents one of the few instances that a revolutionary approach was pursued, yielding previously unfathomable benefits to patients out of realistic therapeutic options. However, as is rather extensively established, nonresponse, or even negative response, to CRT continue to plague its course, precluding favourable effects in up to 40% of recipients, for a multitude of reasons. Given the scope of the issue of nonresponse, attempts to negate it by means of altering CRT delivery mode, and, more specifically, by introducing multipoint left ventricular pacing (MPP) have been focused on. Possible reasons for divergent trial results will be presented, as well as potential criteria for predicting whether MPP activation may reap additional benefits as compared to conventional biventricular pacing (BVP). Finally, an alternative framework for approaching CRT in general will be put forward, including advancements which in the (near) future may once more revolutionise heart failure treatment.
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Affiliation(s)
- Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Panagiotis Xydis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Konstantinos Konstantinou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Nikolaos Magkas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Panagiota Manolakou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Christina Chrysohoou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece
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Kotalczyk A, Kalarus Z, Wright DJ, Boriani G, Lip GYH. Cardiac Electronic Devices: Future Directions and Challenges. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:325-338. [PMID: 33061681 PMCID: PMC7526741 DOI: 10.2147/mder.s245625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are essential management options for patients with brady- and tachyarrhythmias or heart failure with concomitant optimal pharmacotherapy. Despite increasing technological advances, there are still gaps in the management of CIED patients, eg, the growing number of lead- and pocket-related long-term complications, including cardiac device–related infective endocarditis, requires the greatest care. Likewise, patients with CIEDs should be monitored remotely as a part of a comprehensive, holistic management approach. In addition, novel technologies used in smartwatches may be a convenient tool for long-term atrial fibrillation (AF) screening, especially in high-risk populations. Early detection of AF may reduce the risk of stroke and other AF-related complications. The objective of this review article was to provide an overview of novel technologies in cardiac rhythm–management devices and future challenges related to CIEDs.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
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