Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices

A Time-Varying Equivalent Circuit Modeling and Measuring Approach for Intracardiac Communication in Leadless Pacemakers

Intracardiac wireless communication is crucial for the development of multi-chamber leadless cardiac pacemakers (LCP). However, the time-varying characteristics of intracardiac channel pose major challenges. As such, mastering the dynamic conduction properties of the intracardiac channel and modeling the equivalent time-varying channel are imperative for realizing LCP multi-chamber pacing. In this article, we present a limiting volume variational approach based on the electrical properties of cardiac tissues and trends in chamber volume variation. This approach was used to establish a quasi-static and a continuous time-varying equivalent circuit model of an intracardiac channel. An equivalence analysis was conducted on the model, and a discrete time-varying equivalent circuit phantom grounded on the cardiac cycle was subsequently established. Moreover, an ex vivo cardiac experimental platform was developed for verification. Results indicate that in the frequency domain, the congruence between phantom and ex vivo experimental outcomes is as high as 94.3%, affirming the reliability of the equivalent circuit model. In the time domain, the correlation is up to 75.3%, corroborating its effectiveness. The proposed time-varying equivalent circuit model exhibits stable and standardized dynamic attributes, serving as a powerful tool for addressing time-varying challenges and simplifying in vivo or ex vivo experiments.

Regional Left Ventricular Fiber Stress Analysis for Cardiac Resynchronization Therapy Response

Cardiac resynchronization therapy (CRT) is an effective treatment for a subgroup of heart failure (HF) patients, but more than 30% of those selected do not improve after CRT implantation. Imperfect pre-procedural criteria for patient selection and optimization are the main causes of the high non-response rate. In this study, we evaluated a novel measure for assessing CRT response. We used a computational modeling framework to calculate the regional stress of the left ventricular wall of seven CRT patients and seven healthy controls. The standard deviation of regional wall stress at the time of mitral valve closure (SD_MVC) was used to quantify dyssynchrony and compared between patients and controls and among the patients. The results show that SD_MVC is significantly lower in controls than patients and correlates with long-term response in patients, based on end-diastolic volume reduction. In contrast to our initial hypothesis, patients with lower SD_MVC respond better to therapy. The patient with the highest SD_MVC was the only non-responder in the patient cohort. The distribution of fiber stress at the beginning of the isovolumetric phase seems to correlate with the degree of response and the use of this measurement could potentially improve selection criteria for CRT implantation. Further studies with a larger cohort of patients are needed to validate these results.

Recent Trends, Construction and Applications of Smart Textiles and Clothing for Monitoring of Health Activity: A Comprehensive Multidisciplinary Review

In the area of biomedical signal monitoring, wearable electronics represents a dynamically growing field with a significant impact on the market of commercial products of biomedical signal monitoring and acquisition, as well as consumer electronic for vital functions monitoring. Since the electrodes are perceived as one of the most important part of the biomedical signal monitoring, they have been one of the most frequent subjects in the research community. Electronic textile (e-textile), also called smart textile represents a modern trend in the wearable electronics, integrating of functional materials with common clothing with the goal to realize the devices, which include sensors, antennas, energy harvesters and advanced textiles for self-cooling and heating. The area of textile electrodes and e-textile is perceived as a multidisciplinary field, integrating material engineering, chemistry, and biomedical engineering. In this review, we provide a comprehensive view on this area. This multidisciplinary review integrates the e-textile characteristics, materials and manufacturing of the textile electrodes, noise influence on the e-textiles performance, and mainly applications of the textile electrodes for biomedical signal monitoring and acquisition, including pressure sensors, electrocardiography, electromyography, electroencephalography and electrooculography monitoring.

Optimal pacing sites in cardiac resynchronization by left ventricular activation front analysis

Cardiac resynchronization therapy (CRT) can substantially improve dyssynchronous heart failure and reduce mortality. However, about one-third of patients who are implanted, derive no measurable benefit from CRT. Non-response may partly be due to suboptimal activation of the left ventricle (LV) caused by electrophysiological heterogeneities. The goal of this study is to investigate the performance of a newly developed method used to analyze electrical wavefront propagation in a heart model including myocardial scar and compare this to clinical benchmark studies. We used computational models to measure the maximum activation front (MAF) in the LV during different pacing scenarios. Different heart geometries and scars were created based on cardiac MR images of three patients. The right ventricle (RV) was paced from the apex and the LV was paced from 12 different sites, single site, dual-site and triple site. Our results showed that for single LV site pacing, the pacing site with the largest MAF corresponded with the latest activated regions of the LV demonstrated during RV pacing, which also agrees with previous markers used for predicting optimal single-site pacing location. We then demonstrated the utility of MAF in predicting optimal electrode placements in more complex scenarios including scar and multi-site LV pacing. This study demonstrates the potential value of computational simulations in understanding and planning CRT.