Research ArticleBioengineering

Electromechanical cardioplasty using a wrapped elasto-conductive epicardial mesh

Science Translational Medicine  22 Jun 2016:
Vol. 8, Issue 344, pp. 344ra86
DOI: 10.1126/scitranslmed.aad8568

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An electromechanical hug for the heart

Heart failure can be treated by pacemakers to keep the beats in rhythm, but pacemakers apply electrical stimulation at specific points and do not provide comprehensive coverage of the entire organ. Park and colleagues therefore devised an electric mesh that wraps around the heart to deliver electrical impulses to the whole ventricular myocardium. The heart wrap was made from silver nanowires embedded in a rubber polymer that could conform to the unique three-dimensional anatomy of different hearts. In rats that had a heart attack, the mesh integrated structurally and electrically with the myocardium and exerted beneficial effects, including preserved diastolic relaxation, reduced wall stress, and improved cardiac contractile function. The mesh also terminated induced ventricular arrhythmia, acting as an epicardial defibrillator. Such epicardial meshes have been tested in clinical trials before and were effective in preventing ventricular remodeling but showed controversial results in long-term survival. The authors hope that their device, which is designed to integrate more faithfully with the heart’s structure and electrical conduction system, is more consistent in people.

Abstract

Heart failure remains a major public health concern with a 5-year mortality rate higher than that of most cancers. Myocardial disease in heart failure is frequently accompanied by impairment of the specialized electrical conduction system and myocardium. We introduce an epicardial mesh made of electrically conductive and mechanically elastic material, to resemble the innate cardiac tissue and confer cardiac conduction system function, to enable electromechanical cardioplasty. Our epicardium-like substrate mechanically integrated with the heart and acted as a structural element of cardiac chambers. The epicardial device was designed with elastic properties nearly identical to the epicardial tissue itself and was able to detect electrical signals reliably on the moving rat heart without impeding diastolic function 8 weeks after induced myocardial infarction. Synchronized electrical stimulation over the ventricles by the epicardial mesh with the high conductivity of 11,210 S/cm shortened total ventricular activation time, reduced inherent wall stress, and improved several measures of systolic function including increases of 51% in fractional shortening, ~90% in radial strain, and 42% in contractility. The epicardial mesh was also capable of delivering an electrical shock to terminate a ventricular tachyarrhythmia in rodents. Electromechanical cardioplasty using an epicardial mesh is a new pathway toward reconstruction of the cardiac tissue and its specialized functions.

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