A bioadhesive pacing lead for atraumatic cardiac monitoring and stimulation in rodent and porcine models

Current clinically used electronic implants, including cardiac pacing leads for epicardial monitoring and stimulation of the heart, rely on surgical suturing or direct insertion of electrodes to the heart tissue. These approaches can cause tissue trauma during the implantation and retrieval of the pacing leads, with the potential for bleeding, tissue damage, and device failure. Here, we report a bioadhesive pacing lead that can directly interface with cardiac tissue through physical and covalent interactions to support minimally invasive adhesive implantation and gentle on-demand removal of the device with a detachment solution. We developed 3D-printable bioadhesive materials for customized fabrication of the device by graft-polymerizing polyacrylic acid on hydrophilic polyurethane and mixing with poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) to obtain electrical conductivity. The bioadhesive construct exhibited mechanical properties similar to cardiac tissue and strong tissue adhesion, supporting stable electrical interfacing. Infusion of a detachment solution to cleave physical and covalent cross-links between the adhesive interface and the tissue allowed retrieval of the bioadhesive pacing leads in rat and porcine models without apparent tissue damage. Continuous and reliable cardiac monitoring and pacing of rodent and porcine hearts were demonstrated for 2 weeks with consistent capture threshold and sensing amplitude, in contrast to a commercially available alternative. Pacing and continuous telemetric monitoring were achieved in a porcine model. These findings may offer a promising platform for adhesive bioelectronic devices for cardiac monitoring and treatment.

Materials and Structural Designs toward Motion Artifact-Free Bioelectronics

Bioelectronics encompassing electronic components and circuits for accessing human information play a vital role in real-time and continuous monitoring of biophysiological signals of electrophysiology, mechanical physiology, and electrochemical physiology. However, mechanical noise, particularly motion artifacts, poses a significant challenge in accurately detecting and analyzing target signals. While software-based "postprocessing" methods and signal filtering techniques have been widely employed, challenges such as signal distortion, major requirement of accurate models for classification, power consumption, and data delay inevitably persist. This review presents an overview of noise reduction strategies in bioelectronics, focusing on reducing motion artifacts and improving the signal-to-noise ratio through hardware-based approaches such as "preprocessing". One of the main stress-avoiding strategies is reducing elastic mechanical energies applied to bioelectronics to prevent stress-induced motion artifacts. Various approaches including strain-compliance, strain-resistance, and stress-damping techniques using unique materials and structures have been explored. Future research should optimize materials and structure designs, establish stable processes and measurement methods, and develop techniques for selectively separating and processing overlapping noises. Ultimately, these advancements will contribute to the development of more reliable and effective bioelectronics for healthcare monitoring and diagnostics.

Permeable Bioelectronics toward Biointegrated Systems

Bioelectronics integrates electronics with biological organs, sustaining the natural functions of the organs. Organs dynamically interact with the external environment, managing internal equilibrium and responding to external stimuli. These interactions are crucial for maintaining homeostasis. Additionally, biological organs possess a soft and stretchable nature; encountering objects with differing properties can disrupt their function. Therefore, when electronic devices come into contact with biological objects, the permeability of these devices, enabling interactions and substance exchanges with the external environment, and the mechanical compliance are crucial for maintaining the inherent functionality of biological organs. This review discusses recent advancements in soft and permeable bioelectronics, emphasizing materials, structures, and a wide range of applications. The review also addresses current challenges and potential solutions, providing insights into the integration of electronics with biological organs.

Stretchable Functional Nanocomposites for Soft Implantable Bioelectronics

Material advances in soft bioelectronics, particularly those based on stretchable nanocomposites─functional nanomaterials embedded in viscoelastic polymers with irreversible or reversible bonds─have driven significant progress in translational medical device research. The unique mechanical properties inherent in the stretchable nanocomposites enable stiffness matching between tissue and device, as well as its spontaneous mechanical adaptation to in vivo environments, minimizing undesired mechanical stress and inflammation responses. Furthermore, these properties allow percolative networks of conducting fillers in the nanocomposites to be sustained even under repetitive tensile/compressive stresses, leading to stable tissue-device interfacing. Here, we present an in-depth review of materials strategies, fabrication/integration techniques, device designs, applications, and translational opportunities of nanocomposite-based soft bioelectronics, which feature intrinsic stretchability, self-healability, tissue adhesion, and/or syringe injectability. Among many, applications to brain, heart, and peripheral nerves are predominantly discussed, and translational studies in certain domains such as neuromuscular and cardiovascular engineering are particularly highlighted.

Next-Generation Cardiac Interfacing Technologies Using Nanomaterial-Based Soft Bioelectronics

Cardiac interfacing devices are essential components for the management of cardiovascular diseases, particularly in terms of electrophysiological monitoring and implementation of therapies. However, conventional cardiac devices are typically composed of rigid and bulky materials and thus pose significant challenges for effective long-term interfacing with the curvilinear surface of a dynamically beating heart. In this regard, the recent development of intrinsically soft bioelectronic devices using nanocomposites, which are fabricated by blending conductive nanofillers in polymeric and elastomeric matrices, has shown great promise. The intrinsically soft bioelectronics not only endure the dynamic beating motion of the heart and maintain stable performance but also enable conformal, reliable, and large-area interfacing with the target cardiac tissue, allowing for high-quality electrophysiological mapping, feedback electrical stimulations, and even mechanical assistance. Here, we explore next-generation cardiac interfacing strategies based on soft bioelectronic devices that utilize elastic conductive nanocomposites. We first discuss the conventional cardiac devices used to manage cardiovascular diseases and explain their undesired limitations. Then, we introduce intrinsically soft polymeric materials and mechanical restraint devices utilizing soft polymeric materials. After the discussion of the fabrication and functionalization of conductive nanomaterials, the introduction of intrinsically soft bioelectronics using nanocomposites and their application to cardiac monitoring and feedback therapy follow. Finally, comments on the future prospects of soft bioelectronics for cardiac interfacing technologies are discussed.

Stretchable Electrodes with Interfacial Percolation Network

Stretchable electrodes are an essential component that determines the functionality and reliability of stretchable electronics, but face the challenge of balancing conductivity and stretchability. This work proposes a new conducting concept called the interfacial percolation network (PN) that results in stretchable electrodes with high conductivity, large stretchability, and high stability. The interfacial PN is composed of a 2D silver nanowires (AgNWs) PN and a protruding 3D AgNWs PN embedded on the surface and in the near-surface region of an elastic polymer matrix, respectively. The protruded PN is obtained by changing the arrangements of AgNWs from horizontal to quasi-vertical through introducing foreign polymer domains in the near-surface region of the polymer matrix. The resulting electrode achieves a conductivity of 13 500 S cm-1 and a stretchability of 660%. Its resistance changes under stretched conditions are orders of magnitude lower than those of conventional 2D PN and 2D + 3D PN. An interfacial PN electrode made from liquid metal remained its conductivity at 46 750 S cm-1 after the electrode underwent multiple stretch-release cycles with a deformation of >600%. The concept of interfacial PN provides fruitful implications for the design of stretchable electronics.

Wireless Battery-free and Fully Implantable Organ Interfaces

Advances in soft materials, miniaturized electronics, sensors, stimulators, radios, and battery-free power supplies are resulting in a new generation of fully implantable organ interfaces that leverage volumetric reduction and soft mechanics by eliminating electrochemical power storage. This device class offers the ability to provide high-fidelity readouts of physiological processes, enables stimulation, and allows control over organs to realize new therapeutic and diagnostic paradigms. Driven by seamless integration with connected infrastructure, these devices enable personalized digital medicine. Key to advances are carefully designed material, electrophysical, electrochemical, and electromagnetic systems that form implantables with mechanical properties closely matched to the target organ to deliver functionality that supports high-fidelity sensors and stimulators. The elimination of electrochemical power supplies enables control over device operation, anywhere from acute, to lifetimes matching the target subject with physical dimensions that supports imperceptible operation. This review provides a comprehensive overview of the basic building blocks of battery-free organ interfaces and related topics such as implantation, delivery, sterilization, and user acceptance. State of the art examples categorized by organ system and an outlook of interconnection and advanced strategies for computation leveraging the consistent power influx to elevate functionality of this device class over current battery-powered strategies is highlighted.

Injectable Mesh-Like Conductive Hydrogel Patch for Elimination of Atrial Fibrillation

Irregular electrical impulses in atrium are the leading cause of atrial fibrillation (AF), resulting in fatal arrhythmia and sudden cardiac death. Traditional medication and physical therapies are widely used, but generally suffer problems in serious physical damage and high surgical risks. Flexible and soft implants have great potential to be a novel approach for heart diseases therapy. A conductive hydrogel-based mesh cardiac patch is developed for application in AF elimination. The designed mesh patch with rhombic-shaped structure exhibits excellent flexibility, surface conformability, and deformation compliance, making it fit well with heart surface and accommodate to the deformation during heart beating. Moreover, the mechanical elastic and shape-memory properties of the mesh patch enable a minimally invasive injection of the patch into living animals. The mesh patch is implanted on the atrium surface for one month, indicating good biocompatibility and stability. Furthermore, the conductive patch can effectively eliminate AF owing to the conductivity and high charge storage capability (CSC) of the hydrogel. The proposed scheme of cardiac bioelectric signal modulation using conductive hydrogel brings new possibility for the treatment of arrhythmia diseases.

Continuous Biopotential Monitoring via Carbon Nanotubes Paper Composites (CPC) for Sustainable Health Analysis

Skin-based wearable devices have gained significant attention due to advancements in soft materials and thin-film technologies. Nevertheless, traditional wearable electronics often entail expensive and intricate manufacturing processes and rely on metal-based substrates that are susceptible to corrosion and lack flexibility. In response to these challenges, this paper has emerged with an alternative substrate for wearable electrodes due to its cost-effectiveness and scalability in manufacturing. Paper-based electrodes offer an attractive solution with their inherent properties of high breathability, flexibility, biocompatibility, and tunability. In this study, we introduce carbon nanotube-based paper composites (CPC) electrodes designed for the continuous detection of biopotential signals, such as electrooculography (EOG), electrocardiogram (ECG), and electroencephalogram (EEG). To prevent direct skin contact with carbon nanotubes, we apply various packaging materials, including polydimethylsiloxane (PDMS), Eco-flex, polyimide (PI), and polyurethane (PU). We conduct a comparative analysis of their signal-to-noise ratios in comparison to conventional gel electrodes. Our system demonstrates real-time biopotential monitoring for continuous health tracking, utilizing CPC in conjunction with a portable data acquisition system. The collected data are analyzed to provide accurate heart rates, respiratory rates, and heart rate variability metrics. Additionally, we explore the feasibility using CPC for sleep monitoring by collecting EEG signals.

Mechanically-Guided 3D Assembly for Architected Flexible Electronics

Architected flexible electronic devices with rationally designed 3D geometries have found essential applications in biology, medicine, therapeutics, sensing/imaging, energy, robotics, and daily healthcare. Mechanically-guided 3D assembly methods, exploiting mechanics principles of materials and structures to transform planar electronic devices fabricated using mature semiconductor techniques into 3D architected ones, are promising routes to such architected flexible electronic devices. Here, we comprehensively review mechanically-guided 3D assembly methods for architected flexible electronics. Mainstream methods of mechanically-guided 3D assembly are classified and discussed on the basis of their fundamental deformation modes (i.e., rolling, folding, curving, and buckling). Diverse 3D interconnects and device forms are then summarized, which correspond to the two key components of an architected flexible electronic device. Afterward, structure-induced functionalities are highlighted to provide guidelines for function-driven structural designs of flexible electronics, followed by a collective summary of their resulting applications. Finally, conclusions and outlooks are given, covering routes to achieve extreme deformations and dimensions, inverse design methods, and encapsulation strategies of architected 3D flexible electronics, as well as perspectives on future applications.

Flexible electronics for cardiovascular healthcare monitoring

Cardiovascular diseases (CVDs) are one of the most urgent threats to humans worldwide, which are responsible for almost one-third of global mortality. Over the last decade, research on flexible electronics for monitoring and treatment of CVDs has attracted tremendous attention. In contrast to conventional medical instruments in hospitals that are usually bulky, hard to move, monofunctional, and time-consuming, flexible electronics are capable of continuous, noninvasive, real-time, and portable monitoring. Notable progress has been made in this emerging field, and thus a number of significant achievements and concomitant research prospects deserve attention for practical implementation. Here, we comprehensively review the latest progress of flexible electronics for CVDs, focusing on new functions provided by flexible electronics. First, the characteristics of CVDs and flexible electronics and the foundation of their combination are briefly reviewed. Then, four representative applications of flexible electronics for CVDs are elaborated: blood pressure (BP) monitoring, electrocardiogram (ECG) monitoring, echocardiogram monitoring, and direct epicardium monitoring. Their operational principles, progress, merits and demerits, and future efforts are discussed. Finally, the remaining challenges and opportunities for flexible electronics for cardiovascular healthcare are outlined.

Transparent and Stretchable Au─Ag Nanowire Recording Microelectrode Arrays

Transparent microelectrodes have received much attention from the biomedical community due to their unique advantages in concurrent crosstalk-free electrical and optical interrogation of cell/tissue activity. Despite recent progress in constructing transparent microelectrodes, a major challenge is to simultaneously achieve desirable mechanical stretchability, optical transparency, electrochemical performance, and chemical stability for high-fidelity, conformal, and stable interfacing with soft tissue/organ systems. To address this challenge, we have designed microelectrode arrays (MEAs) with gold-coated silver nanowires (Au─Ag NWs) by combining technical advances in materials, fabrication, and mechanics. The Au coating improves both the chemical stability and electrochemical impedance of the Au─Ag NW microelectrodes with only slight changes in optical properties. The MEAs exhibit a high optical transparency >80% at 550 nm, a low normalized 1 kHz electrochemical impedance of 1.2-7.5 Ω cm2, stable chemical and electromechanical performance after exposure to oxygen plasma for 5 min, and cyclic stretching for 600 cycles at 20% strain, superior to other transparent microelectrode alternatives. The MEAs easily conform to curvilinear heart surfaces for colocalized electrophysiological and optical mapping of cardiac function. This work demonstrates that stretchable transparent metal nanowire MEAs are promising candidates for diverse biomedical science and engineering applications, particularly under mechanically dynamic conditions.

Wireless, Fully Implantable and Expandable Electronic System for Bidirectional Electrical Neuromodulation of the Urinary Bladder

Current standard clinical options for patients with detrusor underactivity (DUA) or underactive bladder─the inability to release urine naturally─include the use of medications, voiding techniques, and intermittent catheterization, for which the patient inserts a tube directly into the urethra to eliminate urine. Although those are life-saving techniques, there are still unfavorable side effects, including urinary tract infection (UTI), urethritis, irritation, and discomfort. Here, we report a wireless, fully implantable, and expandable electronic complex that enables elaborate management of abnormal bladder function via seamless integrations with the urinary bladder. Such electronics can not only record multiple physiological parameters simultaneously but also provide direct electrical stimulation based on a feedback control system. Uniform distribution of multiple stimulation electrodes via mesh-type geometry realizes low-impedance characteristics, which improves voiding/urination efficiency at the desired times. In vivo evaluations using live, free-moving animal models demonstrate system-level functionality.

Stretchable Low-Impedance Conductor with Ag-Au-Pt Core-Shell-Shell Nanowires and in Situ Formed Pt Nanoparticles for Wearable and Implantable Device

Mechanically soft metallic nanocomposites have gained much attention as a key material for intrinsically stretchable biointegrated devices. However, it has been challenging to develop a stretchable conductive nanocomposite with all the desired material characteristics including high conductivity, high stretchability, low cytotoxicity, and low impedance. Here, we present a material strategy for the stretchable conductive nanocomposite, particularly emphasizing low impedance, by combining silver-gold-platinum core-shell-shell nanowires and homogeneously dispersed in situ synthesized platinum nanoparticles (Pt NPs). The highly embossed structure of the outermost Pt shell, together with the intrinsic electrical property of Pt, contributes to minimizing the impedance. The gold-platinum double-layer sheath prevents leaching of cytotoxic Ag ions, thus improving biocompatibility. Homogeneously dispersed Pt NPs, synthesized in situ during fabrication of the nanocomposite, simultaneously enhance conductivity, reduce impedance, and improve stretchability by supporting the percolation network formation. This intrinsically stretchable nanocomposite conductor can be applied to wearable and implantable bioelectronics for recording biosignals and delivering electrical stimulations in vivo.

Ultra-stretchable and biodegradable elastomers for soft, transient electronics

As rubber-like elastomers have led to scientific breakthroughs in soft, stretchable characteristics-based wearable, implantable electronic devices or relevant research fields, developments of degradable elastomers with comparable mechanical properties could bring similar technological innovations in transient, bioresorbable electronics or expansion into unexplored areas. Here, we introduce ultra-stretchable, biodegradable elastomers capable of stretching up to ~1600% with outstanding properties in toughness, tear-tolerance, and storage stability, all of which are validated by comprehensive mechanical and biochemical studies. The facile formation of thin films enables the integration of almost any type of electronic device with tunable, suitable adhesive strengths. Conductive elastomers tolerant/sensitive to mechanical deformations highlight possibilities for versatile monitoring/sensing components, particularly the strain-tolerant composites retain high levels of conductivities even under tensile strains of ~550%. Demonstrations of soft electronic grippers and transient, suture-free cardiac jackets could be the cornerstone for sophisticated, multifunctional biodegradable electronics in the fields of soft robots and biomedical implants.

Ventricular tachyarrhythmia treatment and prevention by subthreshold stimulation with stretchable epicardial multichannel electrode array

The implantable cardioverter-defibrillator (ICD) is an effective method to prevent sudden cardiac death in high-risk patients. However, the transvenous lead is incompatible with large-area electrophysiological mapping and cannot accommodate selective multichannel precision stimulations. Moreover, it involves high-energy shocks, resulting in pain, myocardial damage, and recurrences of ventricular tachyarrhythmia (VTA). We present a method for VTA treatment based on subthreshold electrical stimulations using a stretchable epicardial multichannel electrode array, which does not disturb the normal contraction or electrical propagation of the ventricle. In rabbit models with myocardial infarction, the infarction was detected by mapping intracardiac electrograms with the stretchable epicardial multichannel electrode array. Then, VTAs could be terminated by sequential electrical stimuli from the epicardial multichannel electrode array beginning with low-energy subthreshold stimulations. Last, we used these subthreshold stimulations to prevent the occurrence of additional VTAs. The proposed protocol using the stretchable epicardial multichannel electrode array provides opportunities toward the development of innovative methods for painless ICD therapy.

Programming 3D curved mesosurfaces using microlattice designs

Cellular microstructures form naturally in many living organisms (e.g., flowers and leaves) to provide vital functions in synthesis, transport of nutrients, and regulation of growth. Although heterogeneous cellular microstructures are believed to play pivotal roles in their three-dimensional (3D) shape formation, programming 3D curved mesosurfaces with cellular designs remains elusive in man-made systems. We report a rational microlattice design that allows transformation of 2D films into programmable 3D curved mesosurfaces through mechanically guided assembly. Analytical modeling and a machine learning-based computational approach serve as the basis for shape programming and determine the heterogeneous 2D microlattice patterns required for target 3D curved surfaces. About 30 geometries are presented, including both regular and biological mesosurfaces. Demonstrations include a conformable cardiac electronic device, a stingray-like dual mode actuator, and a 3D electronic cell scaffold.

Ultrasoft and Biocompatible Magnetic-Hydrogel-Based Strain Sensors for Wireless Passive Biomechanical Monitoring

Implantable flexible mechanical sensors have exhibited great potential in health monitoring and disease diagnosis due to continuous and real-time monitoring capability. However, the wires and power supply required in current devices cause inconvenience and potential risks. Magnetic-based devices have demonstrated advantages in wireless and passive sensing, but the mismatched mechanical properties, poor biocompatibility, and insufficient sensitivity have limited their applications in biomechanical monitoring. Here, a wireless and passive flexible magnetic-based strain sensor based on a gelatin methacrylate/Fe₃O₄ magnetic hydrogel has been fabricated. The sensor exhibits ultrasoft mechanical properties, strong magnetic properties, and long-term stability in saline solution and can monitor strains down to 50 μm. A model of the sensing process is established to identify the optimal detection location and the relation between the relative magnetic permeability and the sensitivity of the sensors. Moreover, an in vitro tissue model is developed to investigate the potential of the sensor in detecting subtle biomechanical signals and avoiding interference with bioactivities. Furthermore, a real-time and high-throughput biomonitoring platform is built and implements passive wireless monitoring of the drug response and cultural status of the cardiomyocytes. This work demonstrates the potential of applying magnetic sensing for biomechanical monitoring and provides ideas for the design of wireless and passive implantable devices.

Advances in Materials, Sensors, and Integrated Systems for Monitoring Eye Movements

Eye movements show primary responses that reflect humans' voluntary intention and conscious selection. Because visual perception is one of the fundamental sensory interactions in the brain, eye movements contain critical information regarding physical/psychological health, perception, intention, and preference. With the advancement of wearable device technologies, the performance of monitoring eye tracking has been significantly improved. It also has led to myriad applications for assisting and augmenting human activities. Among them, electrooculograms, measured by skin-mounted electrodes, have been widely used to track eye motions accurately. In addition, eye trackers that detect reflected optical signals offer alternative ways without using wearable sensors. This paper outlines a systematic summary of the latest research on various materials, sensors, and integrated systems for monitoring eye movements and enabling human-machine interfaces. Specifically, we summarize recent developments in soft materials, biocompatible materials, manufacturing methods, sensor functions, systems' performances, and their applications in eye tracking. Finally, we discuss the remaining challenges and suggest research directions for future studies.

Curvilinear soft electronics by micromolding of metal nanowires in capillaries

Soft electronics using metal nanowires have attracted notable attention attributed to their high electrical conductivity and mechanical flexibility. However, high-resolution complex patterning of metal nanowires on curvilinear substrates remains a challenge. Here, a micromolding-based method is reported for scalable printing of metal nanowires, which enables complex and highly conductive patterns on soft curvilinear and uneven substrates with high resolution and uniformity. Printing resolution of 20 μm and conductivity of the printed patterns of ~6.3 × 10⁶ S/m are achieved. Printing of grid structures with uniform thickness for transparent conductive electrodes (TCEs) and direct printing of pressure sensors on curved surfaces such as glove and contact lens are also realized. The printed hybrid soft TCEs and smart contact lens show promising applications in optoelectronic devices and personal health monitoring, respectively. This printing method can be extended to other nanomaterials for large-scale printing of high-performance soft electronics.

In situ diagnosis and simultaneous treatment of cardiac diseases using a single-device platform

The in situ diagnosis of cardiac activities with simultaneous therapeutic electrical stimulation of the heart is key to preventing cardiac arrhythmia. Here, we present an unconventional single-device platform that enables in situ monitoring even in a wet condition and control of beating heart motions without interferences to the recording signal. This platform consists of the active-matrix array of pressure-sensitive transistors for detecting cardiac beatings, biocompatible, low-impedance electrodes for cardiac stimulations, and an alginate-based hydrogel adhesive for attaching this platform conformally to the epicardium. In contrast to conventional electrophysiological sensing using electrodes, the pressure-sensitive transistors measured mechanophysiological characteristics by monitoring the spatiotemporal distributions of cardiac pressures during heart beating motions. In vivo tests show mechanophysiological readings having good correlation with electrocardiography and negligible interference with the electrical artifacts caused during cardiac stimulations. This platform can therapeutically synchronize the rhythm of abnormal heartbeats through efficient pacing of cardiac arrhythmia.

Photopatternable Poly(dimethylsiloxane) (PDMS) for an Intrinsically Stretchable Organic Electrochemical Transistor

Patterning elastomers is an essential process for the application of elastomers to stretchable bioelectric devices. In general, replication of a mold and laser ablation are used for patterning elastomers. However, these methods are inefficient and time consuming due to complex patterning procedures and a heat-induced curing mechanism. In this work, we developed a photopatternable elastomer called thiol-ene cross-linked poly(dimethylsiloxane) (TC-PDMS). TC-PDMS showed high-resolution patternability (∼100 μm) through a direct patterning process. It also had high stretchability (∼140%) and low Young's modulus (∼2.9 MPa) similar to conventional PDMS. To demonstrate its practicability in stretchable bioelectric devices, TC-PDMS was applied to a passivation layer of an intrinsically stretchable organic electrochemical transistor (OECT), which showed a low leakage current (∼20 μA) and a high transconductance (0.432 mS) at high strain (60%). The stretchable OECT was able to record electrocardiographic (ECG) signals from human skin, and the measured ECG signals exhibited a high signal-to-noise ratio of 12.2 dB.

Emerging Bioelectronic Strategies for Cardiovascular Tissue Engineering and Implantation

Heart diseases are currently the leading cause of death worldwide. The ability to create cardiovascular tissue has numerous applications in understanding tissue development, disease progression, pharmacological testing, bio-actuators, and transplantation; yet current cardiovascular tissue engineering (CTE) methods are limited. However, there have been emerging developments in the bioelectronics field, with the creation of biomimetic devices that can intimately interact with cardiac cells, provide monitoring capabilities, and regulate tissue formation. Combining bioelectronics with cardiac tissue engineering can overcome current limitations and produce physiologically relevant tissue that can be used in various areas of cardiovascular research and medicine. This review highlights the recent advances in cardiovascular-based bioelectronics. First, cardiac tissue engineering and the potential of bioelectronic therapies for cardiovascular diseases are discussed. Second, advantageous bioelectronic materials for CTE and implantation and their properties are reviewed. Third, several representative cardiovascular tissue-bioelectronic interface models and the beneficial functions that bioelectronics can demonstrate in in vitro and in vivo applications are explored. Finally, the prospects and remaining challenges for clinical application are discussed.

Flexible Sensory Systems: Structural Approaches

Biology is characterized by smooth, elastic, and nonplanar surfaces; as a consequence, soft electronics that enable interfacing with nonplanar surfaces allow applications that could not be achieved with the rigid and integrated circuits that exist today. Here, we review the latest examples of technologies and methods that can replace elasticity through a structural approach; these approaches can modify mechanical properties, thereby improving performance, while maintaining the existing material integrity. Furthermore, an overview of the recent progress in wave/wrinkle, stretchable interconnect, origami/kirigami, crack, nano/micro, and textile structures is provided. Finally, potential applications and expected developments in soft electronics are discussed.

Soft bioelectronics for cardiac interfaces

Bioelectronics for interrogation and intervention of cardiac systems is important for the study of cardiac health and disease. Interfacing cardiac systems by using conventional rigid bioelectronics is limited by the structural and mechanical disparities between rigid electronics and soft tissues as well as their limited performance. Recently, advances in soft electronics have led to the development of high-performance soft bioelectronics, which is flexible and stretchable, capable of interfacing with cardiac systems in ways not possible with conventional rigid bioelectronics. In this review, we first review the latest developments in building flexible and stretchable bioelectronics for the epicardial interface with the heart. Next, we introduce how stretchable bioelectronics can be integrated with cardiac catheters for a minimally invasive in vivo heart interface. Then, we highlight the recent progress in the design of soft bioelectronics as a new class of biomaterials for integration with different in vitro cardiac models. In particular, we highlight how these devices unlock opportunities to interrogate the cardiac activities in the cardiac patch and cardiac organoid models. Finally, we discuss future directions and opportunities using soft bioelectronics for the study of cardiac systems.

Recent Progress in Materials Chemistry to Advance Flexible Bioelectronics in Medicine

Designing bioelectronic devices that seamlessly integrate with the human body is a technological pursuit of great importance. Bioelectronic medical devices that reliably and chronically interface with the body can advance neuroscience, health monitoring, diagnostics, and therapeutics. Recent major efforts focus on investigating strategies to fabricate flexible, stretchable, and soft electronic devices, and advances in materials chemistry have emerged as fundamental to the creation of the next generation of bioelectronics. This review summarizes contemporary advances and forthcoming technical challenges related to three principal components of bioelectronic devices: i) substrates and structural materials, ii) barrier and encapsulation materials, and iii) conductive materials. Through notable illustrations from the literature, integration and device fabrication strategies and associated challenges for each material class are highlighted.

Highly sensitive, flexible and biocompatible temperature sensor utilizing ultra-long Au@AgNW-based polymeric nanocomposites

Owing to their excellent sensitivity, stretchability, flexibility and conductivity, polymeric nanocomposites with conductive fillers have shown promise for a wide range of applications in bioelectronics and wearable devices. Herein, we report on the development of a flexible and biocompatible polymeric nanocomposite comprising ultra-long Ag-Au core-sheath nanowires (Au@AgNWs) dispersed in elastomeric media to fabricate a high-resolution wearable temperature sensor. Ultra-long AgNWs with an aspect ratio of about 1500 were synthesized using a Ca²⁺ ion-mediated facile one-pot polyol process. To enhance the biocompatibility and anti-oxidative property of the AgNWs, a 10-20 nm gold (Au) layer was conformably deposited without affecting the original nanowire morphology. The core-sheath structure of Au@AgNWs was characterized using HRTEM and EDS elemental mapping while the biocompatibility and anti-oxidative properties were tested using hydrogen peroxide (H₂O₂) etching in solution phase. Finally, the fabricated nanowires were used to prepare the Au@AgNW-poly-ethylene glycol (PEG)-polyurethane (PU)-based nanocomposite ink which can be printed on interdigitated electrodes to fabricate a thermoresistive temperature sensor with negative temperature coefficient (NTC) of resistance and quick response time (<100 s). The Au@AgNW-PEG-PU nanocomposite was characterized in detail and a novel temperature sensing mechanism based on controlling the internanowire distance of the PEG coated Au@AgNWs percolation by means of capillarity force among the nanowires as a result of the glass transition temperature of thermosensitive PEG was demonstrated. The proposed printable temperature sensor is flexible and biocompatible and shows promise for a range of wearable applications.

Patterning of Metal Nanowire Networks: Methods and Applications

With the advance in flexible and stretchable electronics, one-dimensional nanomaterials such as metal nanowires have drawn much attention in the past 10 years or so. Metal nanowires, especially silver nanowires, have been recognized as promising candidate materials for flexible and stretchable electronics. Owing to their high electrical conductivity and high aspect ratio, metal nanowires can form electrical percolation networks, maintaining high electrical conductivity under deformation (e.g., bending and stretching). Apart from coating metal nanowires for making large-area transparent conductive films, many applications require patterned metal nanowires as electrodes and interconnects. Precise patterning of metal nanowire networks is crucial to achieve high device performances. Therefore, a high-resolution, designable, and scalable patterning of metal nanowire networks is important but remains a critical challenge for fabricating high-performance electronic devices. This review summarizes recent advances in patterning of metal nanowire networks, using subtractive methods, additive methods of nanowire dispersions, and printing methods. Representative device applications of the patterned metal nanowire networks are presented. Finally, challenges and important directions in the area of the patterning of metal nanowire networks for device applications are discussed.

Soft Bioelectronics Based on Nanomaterials

Recent advances in nanostructured materials and unconventional device designs have transformed the bioelectronics from a rigid and bulky form into a soft and ultrathin form and brought enormous advantages to the bioelectronics. For example, mechanical deformability of the soft bioelectronics and thus its conformal contact onto soft curved organs such as brain, heart, and skin have allowed researchers to measure high-quality biosignals, deliver real-time feedback treatments, and lower long-term side-effects in vivo. Here, we review various materials, fabrication methods, and device strategies for flexible and stretchable electronics, especially focusing on soft biointegrated electronics using nanomaterials and their composites. First, we summarize top-down material processing and bottom-up synthesis methods of various nanomaterials. Next, we discuss state-of-the-art technologies for intrinsically stretchable nanocomposites composed of nanostructured materials incorporated in elastomers or hydrogels. We also briefly discuss unconventional device design strategies for soft bioelectronics. Then individual device components for soft bioelectronics, such as biosensing, data storage, display, therapeutic stimulation, and power supply devices, are introduced. Afterward, representative application examples of the soft bioelectronics are described. A brief summary with a discussion on remaining challenges concludes the review.

2D Materials for Skin-Mountable Electronic Devices

Skin-mountable devices that can directly measure various biosignals and external stimuli and communicate the information to the users have been actively studied owing to increasing demand for wearable electronics and newer healthcare systems. Research on skin-mountable devices is mainly focused on those materials and mechanical design aspects that satisfy the device fabrication requirements on unusual substrates like skin and also for achieving good sensing capabilities and stable device operation in high-strain conditions. 2D materials that are atomically thin and possess unique electrical and optical properties offer several important features that can address the challenging needs in wearable, skin-mountable electronic devices. Herein, recent research progress on skin-mountable devices based on 2D materials that exhibit a variety of device functions including information input and output and in vitro and in vivo healthcare and diagnosis is reviewed. The challenges, potential solutions, and perspectives on trends for future work are also discussed.

Mitral valve replacement and implantation of an extracardial mesh frame in patients with severe heart failure: results of a clinical study and a description of a clinical case 18 years after surgery

Aim    Dilated cardiomyopathy (DCMP) is a major cause for severe heart failure. Development of a combination (drug and surgery) treatment of this disease is relevant. This prospective observational study was aimed at evaluating short- and long-term results of extracardiac mesh implantation in DCMP patients with heart failure resistant to the optimum drug therapy.Material and methods    The extracardiac mesh ACOR-1 was implanted in 15 patients with DCMP. All meshes were produced individually for each patient and made of Gelweave (great Britain) vascular graft strips. The mesh size corresponded to the heart diastolic size, which was measured after achieving a maximum possible clinical improvement for the patient. Long-term results were followed for up to 4 years. Mean age of patients was 43.1±10.8 years (from 28 to 62 years). One patient was followed up for 18 years. Data of that patient were presented as a clinical case report.Results    From October, 2003 through October, 2007, 15 DCMP patients received mesh implants. Cases of in-hospital death were absent. In 3 mos. after the surgery, left ventricular volumes decreased (end-diastolic volume decreased from 251.7±80.7 to 229.0±61.3 ml; end-systolic volume decreased from 182.3±73.6 to 167.7±46.2 ml), and the left ventricular pump function improved (ejection fraction increased from 25.2±6.0 to 27.1±5.1 %; cardiac index increased from 2.0±0.5 to 2.4±0.7 ml /min /m2). The functional state of patients improved by one NYHA class, from 3.7±0.3 to 2.8±0.6. In some cases, the left ventricular size and the systolic function completely normalized. There were no episodes of circulatory decompensation in the long term after surgery. Actuarial survival for the observation period was 100%.Conclusion    Implantation of extracardiac mesh prevented progression of heart dilatation and, in combination with drug therapy, it may represent an effective method for treatment of DCMP.

Reconstituting electrical conduction in soft tissue: the path to replace the ablationist

Cardiac arrhythmias are a leading cause of morbidity and mortality in the developed world. A common mechanism underlying many of these arrhythmias is re-entry, which may occur when native conduction pathways are disrupted, often by myocardial infarction. Presently, re-entrant arrhythmias are most commonly treated with antiarrhythmic drugs and myocardial ablation, although both treatment methods are associated with adverse side effects and limited efficacy. In recent years, significant advancements in the field of biomaterials science have spurred increased interest in the development of novel therapies that enable restoration of native conduction in damaged or diseased myocardium. In this review, we assess the current landscape of materials-based approaches to eliminating re-entrant arrhythmias. These approaches potentially pave the way for the eventual replacement of myocardial ablation as a preferred therapy for such pathologies.

Flexible Electrodes for In Vivo and In Vitro Electrophysiological Signal Recording

A variety of electrophysiological signals (electrocardiography, electromyography, electroencephalography, etc.) are generated during the physiological activities of human bodies, which can be collected by electrodes and thus provide critical insights into health status or facilitate fundamental scientific research. The long-term stable and high-quality recording of electrophysiological signals is the premise for their further applications, leading to demands for flexible electrodes with similar mechanical modulus and minimized irritation to human bodies. This review summarizes the latest advances in flexible electrodes for the acquisition of various electrophysiological signals. First, the concept of electrophysiological signals and the characteristics of different subcategory signals are introduced. Second, the invasive and noninvasive methods are reviewed for electrophysiological signal recording with a highlight on the design of flexible electrodes, followed by a discussion on their material selection. Subsequently, the applications of the electrophysiological signal acquisition in pathological diagnosis and restoration of body functions are discussed, showing the advantages of flexible electrodes. Finally, the main challenges and opportunities in this field are discussed. It is believed that the further exploration of materials for flexible electrodes and the combination of multidisciplinary technologies will boost the applications of flexible electrodes for medical diagnosis and human-machine interface.

Functionalized Elastomers for Intrinsically Soft and Biointegrated Electronics

Elastomers are suitable materials for constructing a conformal interface with soft and curvilinear biological tissue due to their intrinsically deformable mechanical properties. Intrinsically soft electronic devices whose mechanical properties are comparable to human tissue can be fabricated using suitably functionalized elastomers. This article reviews recent progress in functionalized elastomers and their application to intrinsically soft and biointegrated electronics. Elastomers can be functionalized by adding appropriate fillers, either nanoscale materials or polymers. Conducting or semiconducting elastomers synthesized and/or processed with these materials can be applied to the fabrication of soft biointegrated electronic devices. For facile integration of soft electronics with the human body, additional functionalization strategies can be employed to improve adhesive or autonomous healing properties. Recently, device components for intrinsically soft and biointegrated electronics, including sensors, stimulators, power supply devices, displays, and transistors, have been developed. Herein, representative examples of these fully elastomeric device components are discussed. Finally, the remaining challenges and future outlooks for the field are presented.

Wireless Power Transfer and Telemetry for Implantable Bioelectronics

Implantable bioelectronic devices are becoming useful and prospective solutions for various diseases owing to their ability to monitor or manipulate body functions. However, conventional implantable devices (e.g., pacemaker and neurostimulator) are still bulky and rigid, which is mostly due to the energy storage component. In addition to mechanical mismatch between the bulky and rigid implantable device and the soft human tissue, another significant drawback is that the entire device should be surgically replaced once the initially stored energy is exhausted. Besides, retrieving physiological information across a closed epidermis is a tricky procedure. However, wireless interfaces for power and data transfer utilizing radio frequency (RF) microwave offer a promising solution for resolving such issues. While the RF interfacing devices for power and data transfer are extensively investigated and developed using conventional electronics, their application to implantable bioelectronics is still a challenge owing to the constraints and requirements of in vivo environments, such as mechanical softness, small module size, tissue attenuation, and biocompatibility. This work elucidates the recent advances in RF-based power transfer and telemetry for implantable bioelectronics to tackle such challenges.

Superior galvanostatic electrochemical deposition of platinum nanograss provides high performance planar microelectrodes forin vitroneural recording

Objective.Platinum nanograss (Ptng) has been demonstrated as an excellent coating to increase the electrode roughness and reduce the impedance of microelectrodes for neural recording. However, the optimisation of the original potentiostatic electrochemical deposition (PSED) method has been performed by the original group only and noin vitrovalidation of functionality was reported.Approach.This study firstly reinvestigates the use of the PSED method for Ptng coating at different charge densities which highlights non-uniformities in the edges of the microelectrodes for increasing deposition charge densities, leading to a decreased impedance which is in fact an artefact. We then introduce a novel Ptng fabrication method of galvanostatic electrochemical deposition (GSED).Main results.We demonstrate that the GSED deposition method also significantly reduces the electrode impedance, raises the charge storage capacity and provides a significantly more planar electrode surface in comparison to the PSED method with negligible edge effects. In addition, we demonstrate how high-quality neural recordings were performed, for the first time, using the Ptng GSED deposition microelectrodes from human hNT neurons and how spiking and bursting were observed.Significance.Thus, the GSED Ptng deposition method presented here provides an alternative method of microelectrode fabrication for neural applications with excellent impedance and planarity of surface.

Nano- and Microscale Optical and Electrical Biointerfaces and Their Relevance to Energy Research

Different research fields in energy sciences, such as photovoltaics for solar energy conversion, supercapacitors for energy storage, electrocatalysis for clean energy conversion technologies, and materials-bacterial hybrid for CO₂ fixation have been under intense investigations over the past decade. In recent years, new platforms for biointerface designs have emerged from the energy conversion and storage principles. This paper reviews recent advances in nano- and microscale materials/devices for optical and electrical biointerfaces. First, a connection is drawn between biointerfaces and energy science, and how these two distinct research fields can be connected is summarized. Then, a brief overview of current available tools for biointerface studies is presented. Third, three representative biointerfaces are reviewed, including neural, cardiac, and bacterial biointerfaces, to show how to apply these tools and principles to biointerface design and research. Finally, two possible future research directions for nano- and microscale biointerfaces are proposed.

Stem Cells and Their Cardiac Derivatives for Cardiac Tissue Engineering and Regenerative Medicine

Significance: Heart failure is among the leading causes of morbidity worldwide with a 5-year mortality rate of ∼50%. Therefore, major efforts are invested to reduce heart damage upon injury or maintain and at best restore heart function. Recent Advances: In clinical trials, acellular constructs succeeded in improving cardiac function by stabilizing the infarcted heart. In addition, strategies utilizing stem-cell-derived cardiomyocytes have been developed to improve heart function postmyocardial infarction in small and large animal models. These strategies range from injection of cell-laden hydrogels to unstructured hydrogel-based and complex biofabricated cardiac patches. Importantly, novel methods have been developed to promote differentiation of stem-cell-derived cardiomyocytes to prevascularized cardiac patches. Critical Issues: Despite substantial progress in vascularization strategies for heart-on-the-chip technologies, little advance has been made in generating vascularized cardiac patches with clinically relevant dimensions. In addition, proper electrical coupling between engineered and host tissue to prevent and/or eliminate arrhythmia remains an unresolved issue. Finally, despite advanced approaches to include hierarchical structures in cardiac tissues, engineered tissues do not generate forces in the range of native adult cardiac tissue. Future Directions: It involves utilizing novel materials and advancing biofabrication strategies to generate prevascularized three-dimensional multicellular constructs of clinical relevant size; inclusion of hierarchical structures, electroconductive materials, and biologically active factors to enhance cardiomyocyte differentiation for optimized force generation and vascularization; optimization of bioreactor strategies for tissue maturation. Antioxid. Redox Signal. 35, 143-162.

Cardiac mechanostructure: Using mechanics and anisotropy as inspiration for developing epicardial therapies in treating myocardial infarction

The mechanical environment and anisotropic structure of the heart modulate cardiac function at the cellular, tissue and organ levels. During myocardial infarction (MI) and subsequent healing, however, this landscape changes significantly. In order to engineer cardiac biomaterials with the appropriate properties to enhance function after MI, the changes in the myocardium induced by MI must be clearly identified. In this review, we focus on the mechanical and structural properties of the healthy and infarcted myocardium in order to gain insight about the environment in which biomaterial-based cardiac therapies are expected to perform and the functional deficiencies caused by MI that the therapy must address. From this understanding, we discuss epicardial therapies for MI inspired by the mechanics and anisotropy of the heart focusing on passive devices, which feature a biomaterials approach, and active devices, which feature robotic and cellular components. Through this review, a detailed analysis is provided in order to inspire further development and translation of epicardial therapies for MI.

Rapid custom prototyping of soft poroelastic biosensor for simultaneous epicardial recording and imaging

The growing need for the implementation of stretchable biosensors in the body has driven rapid prototyping schemes through the direct ink writing of multidimensional functional architectures. Recent approaches employ biocompatible inks that are dispensable through an automated nozzle injection system. However, their application in medical practices remains challenged in reliable recording due to their viscoelastic nature that yields mechanical and electrical hysteresis under periodic large strains. Herein, we report sponge-like poroelastic silicone composites adaptable for high-precision direct writing of custom-designed stretchable biosensors, which are soft and insensitive to strains. Their unique structural properties yield a robust coupling to living tissues, enabling high-fidelity recording of spatiotemporal electrophysiological activity and real-time ultrasound imaging for visual feedback. In vivo evaluations of custom-fit biosensors in a murine acute myocardial infarction model demonstrate a potential clinical utility in the simultaneous intraoperative recording and imaging on the epicardium, which may guide definitive surgical treatments.

Wearable and Implantable Soft Bioelectronics: Device Designs and Material Strategies

High-performance wearable and implantable devices capable of recording physiological signals and delivering appropriate therapeutics in real time are playing a pivotal role in revolutionizing personalized healthcare. However, the mechanical and biochemical mismatches between rigid, inorganic devices and soft, organic human tissues cause significant trouble, including skin irritation, tissue damage, compromised signal-to-noise ratios, and limited service time. As a result, profuse research efforts have been devoted to overcoming these issues by using flexible and stretchable device designs and soft materials. Here, we summarize recent representative research and technological advances for soft bioelectronics, including conformable and stretchable device designs, various types of soft electronic materials, and surface coating and treatment methods. We also highlight applications of these strategies to emerging soft wearable and implantable devices. We conclude with some current limitations and offer future prospects of this booming field.

Materials, Electrical Performance, Mechanisms, Applications, and Manufacturing Approaches for Flexible Strain Sensors

With the recent great progress made in flexible and wearable electronic materials, the upcoming next generation of skin-mountable and implantable smart devices holds extensive potential applications for the lifestyle modifying, including personalized health monitoring, human-machine interfaces, soft robots, and implantable biomedical devices. As a core member within the wearable electronics family, flexible strain sensors play an essential role in the structure design and functional optimization. To further enhance the stretchability, flexibility, sensitivity, and electricity performances of the flexible strain sensors, enormous efforts have been done covering the materials design, manufacturing approaches and various applications. Thus, this review summarizes the latest advances in flexible strain sensors over recent years from the material, application, and manufacturing strategies. Firstly, the critical parameters measuring the performances of flexible strain sensors and materials development contains different flexible substrates, new nano- and hybrid- materials are introduced. Then, the developed working mechanisms, theoretical analysis, and computational simulation are presented. Next, based on different material design, diverse applications including human motion detection and health monitoring, soft robotics and human-machine interface, implantable devices, and biomedical applications are highlighted. Finally, synthesis consideration of the massive production industry of flexible strain sensors in the future; different fabrication approaches that are fully expected are classified and discussed.

Wearable and Implantable Electroceuticals for Therapeutic Electrostimulations

Wearable and implantable electroceuticals (WIEs) for therapeutic electrostimulation (ES) have become indispensable medical devices in modern healthcare. In addition to functionality, device miniaturization, conformability, biocompatibility, and/or biodegradability are the main engineering targets for the development and clinical translation of WIEs. Recent innovations are mainly focused on wearable/implantable power sources, advanced conformable electrodes, and efficient ES on targeted organs and tissues. Herein, nanogenerators as a hotspot wearable/implantable energy-harvesting technique suitable for powering WIEs are reviewed. Then, electrodes for comfortable attachment and efficient delivery of electrical signals to targeted tissue/organ are introduced and compared. A few promising application directions of ES are discussed, including heart stimulation, nerve modulation, skin regeneration, muscle activation, and assistance to other therapeutic modalities.

Soft Electronics Based on Stretchable and Conductive Nanocomposites for Biomedical Applications

Research on the field of implantable electronic devices that can be directly applied in the body with various functionalities is increasingly intensifying due to its great potential for various therapeutic applications. While conventional implantable electronics generally include rigid and hard conductive materials, their surrounding biological objects are soft and dynamic. The mechanical mismatch between implanted devices and biological environments induces damages in the body especially for long-term applications. Stretchable electronics with outstanding mechanical compliance with biological objects effectively improve such limitations of existing rigid implantable electronics. In this article, the recent progress of implantable soft electronics based on various conductive nanocomposites is systematically described. In particular, representative fabrication approaches of conductive and stretchable nanocomposites for implantable soft electronics and various in vivo applications of implantable soft electronics are focused on. To conclude, challenges and perspectives of current implantable soft electronics that should be considered for further advances are discussed.

Recent advances in three-dimensional microelectrode array technologies for in vitro and in vivo cardiac and neuronal interfaces

Three-dimensional microelectrode arrays (3D MEAs) have emerged as promising tools to detect electrical activities of tissues or organs in vitro and in vivo, but challenges in achieving fast, accurate, and versatile monitoring have consistently hampered further advances in analyzing cell or tissue behaviors. In this review, we discuss emerging 3D MEA technologies for in vitro recording of cardiac and neural cellular electrophysiology, as well as in vivo applications for heart and brain health diagnosis and therapeutics. We first review various forms of recent 3D MEAs for in vitro studies in context of their geometry, materials, and fabrication processes as well as recent demonstrations of 3D MEAs to monitor electromechanical behaviors of cardiomyocytes and neurons. We then present recent advances in 3D MEAs for in vivo applications to the heart and the brain for monitoring of health conditions and stimulation for therapy. A brief overview of the current challenges and future directions of 3D MEAs are provided to conclude the review.