Light transmittance in human atrial tissue and transthoracic illumination in rats support translatability of optogenetic cardioversion of atrial fibrillation

BACKGROUND

Optogenetics could offer a solution to the current lack of an ambulatory method for the rapid automated cardioversion of atrial fibrillation (AF), but key translational aspects remain to be studied.

OBJECTIVE

To investigate whether optogenetic cardioversion of AF is effective in the aged heart and whether sufficient light penetrates the human atrial wall.

METHODS

Atria of adult and aged rats were optogenetically modified to express light-gated ion channels (i.e., red-activatable channelrhodopsin), followed by AF induction and atrial illumination to determine the effectivity of optogenetic cardioversion. The irradiance level was determined by light transmittance measurements on human atrial tissue.

RESULTS

AF could be effectively terminated in the remodeled atria of aged rats (97%, n = 6). Subsequently, ex vivo experiments using human atrial auricles demonstrated that 565-nm light pulses at an intensity of 25 mW/mm2 achieved the complete penetration of the atrial wall. Applying such irradiation onto the chest of adult rats resulted in transthoracic atrial illumination as evidenced by the optogenetic cardioversion of AF (90%, n = 4).

CONCLUSION

Transthoracic optogenetic cardioversion of AF is effective in the aged rat heart using irradiation levels compatible with human atrial transmural light penetration.

Optical ventricular cardioversion by local optogenetic targeting and LED implantation in a cardiomyopathic rat model

AIMS

Ventricular tachyarrhythmias (VTs) are common in the pathologically remodelled heart. These arrhythmias can be lethal, necessitating acute treatment like electrical cardioversion to restore normal rhythm. Recently, it has been proposed that cardioversion may also be realized via optically controlled generation of bioelectricity by the arrhythmic heart itself through optogenetics and therefore without the need of traumatizing high-voltage shocks. However, crucial mechanistic and translational aspects of this strategy have remained largely unaddressed. Therefore, we investigated optogenetic termination of VTs 1) in the pathologically remodelled heart using a 2) implantable multi-LED device for 3) in vivo closed-chest, local illumination.

METHODS AND RESULTS

In order to mimic a clinically relevant sequence of events, transverse aortic constriction (TAC) was applied to adult male Wistar rats before optogenetic modification. This modification took place three weeks later by intravenous delivery of adeno-associated virus vectors encoding red-activatable channelrhodopsin (ReaChR) or Citrine for control experiments. At 8 to 10 weeks after TAC, VTs were induced ex vivo and in vivo, followed by programmed local illumination of the ventricular apex by a custom-made implanted multi-LED device. This resulted in effective and repetitive VT termination in the remodelled adult rat heart after optogenetic modification, leading to sustained restoration of sinus rhythm in the intact animal. Mechanistically, studies on the single cell and tissue level revealed collectively that, despite the cardiac remodelling, there were no significant differences in bioelectricity generation and subsequent transmembrane voltage responses between diseased and control animals, thereby providing insight into the observed robustness of optogenetic VT termination.

CONCLUSION

Our results show that implant-based optical cardioversion of VTs is feasible in the pathologically remodelled heart in vivo after local optogenetic targeting because of preserved optical control over bioelectricity generation. These findings add novel mechanistic and translational insight into optical ventricular cardioversion.

Vertically-Aligned Multi-Walled Carbon Nano Tube Pillars with Various Diameters under Compression: Pristine and NbTiN Coated

In this paper, the compressive stress of pristine and coated vertically-aligned (VA) multi-walled (MW) carbon nanotube (CNT) pillars were investigated using flat-punch nano-indentation. VA-MWCNT pillars of various diameters (30-150 µm) grown by low-pressure chemical vapor deposition on silicon wafer. A conformal brittle coating of niobium-titanium-nitride with high superconductivity temperature was deposited on the VA-MWCNT pillars using atomic layer deposition. The coating together with the pillars could form a superconductive vertical interconnect. The indentation tests showed foam-like behavior of pristine CNTs and ceramic-like fracture of conformal coated CNTs. The compressive strength and the elastic modulus for pristine CNTs could be divided into three regimes of linear elastic, oscillatory plateau, and exponential densification. The elastic modulus of pristine CNTs increased for a smaller pillar diameter. The response of the coated VA-MWCNTs depended on the diffusion depth of the coating in the pillar and their elastic modulus increased with pillar diameter due to the higher sidewall area. Tuning the material properties by conformal coating on various diameter pillars enhanced the mechanical performance and the vertical interconnect access (via) reliability. The results could be useful for quantum computing applications that require high-density superconducting vertical interconnects and reliable operation at reduced temperatures.

An automated hybrid bioelectronic system for autogenous restoration of sinus rhythm in atrial fibrillation

Because of suboptimal therapeutic strategies, restoration of sinus rhythm in symptomatic atrial fibrillation (AF) often requires in-hospital delivery of high-voltage shocks, thereby precluding ambulatory AF termination. Continuous, rapid restoration of sinus rhythm is desired given the recurring and progressive nature of AF. Here, we present an automated hybrid bioelectronic system for shock-free termination of AF that enables the heart to act as an electric current generator for autogenous restoration of sinus rhythm. We show that local, right atrial delivery of adenoassociated virus vectors encoding a light-gated depolarizing ion channel results in efficient and spatially confined transgene expression. Activation of an implanted intrathoracic light-emitting diode device allows for termination of AF by illuminating part of the atria. Combining this newly obtained antiarrhythmic effector function of the heart with the arrhythmia detector function of a machine-based cardiac rhythm monitor in the closed chest of adult rats allowed automated and rapid arrhythmia detection and termination in a safe, effective, repetitive, yet shock-free manner. These findings hold translational potential for the development of shock-free antiarrhythmic device therapy for ambulatory treatment of AF.

High-resolution MEMS inertial sensor combining large-displacement buckling behaviour with integrated capacitive readout

Commercially available gravimeters and seismometers can be used for measuring Earth's acceleration at resolution levels in the order of ng ∕ Hz (where g represents earth's gravity) but they are typically high-cost and bulky. In this work the design of a bulk micromachined MEMS device exploiting non-linear buckling behaviour is described, aiming for ng ∕ Hz resolution by maximising mechanical and capacitive sensitivity. High mechanical sensitivity is obtained through low structural stiffness. Near-zero stiffness is achieved through geometric design and large deformation into a region where the mechanism is statically balanced or neutrally stable. Moreover, the device has an integrated capacitive comb transducer and makes use of a high-resolution impedance readout ASIC. The sensitivity from displacement to a change in capacitance was maximised within the design and process boundaries given, by making use of a trench isolation technique and exploiting the large-displacement behaviour of the device. The measurement results demonstrate that the resonance frequency can be tuned from 8.7 Hz-18.7 Hz, depending on the process parameters and the tilt of the device. In this system, which combines an integrated capacitive transducer with a sensitivity of 2.55 aF/nm and an impedance readout chip, the theoretically achievable system resolution equals 17.02 ng ∕ Hz . The small size of the device and the use of integrated readout electronics allow for a wide range of practical applications for data collection aimed at the internet of things.

2160Continuous shock-free termination of atrial fibrillation by local optogenetic therapy and arrhythmia-triggered activation of an implanted light source

Background

Maintenance of sinus rhythm is the primary therapeutic goal for symptomatic atrial fibrillation (AF) patients but remains difficult to achieve because of suboptimal treatment options. While being effective in detecting and terminating AF, the widespread use of implantable atrial defibrillators is limited due to patients intolerance to repeated shocks. The negative adverse effects of electroshock therapy can hypothetically be overcome by allowing the heart itself to produce the electric current required for arrhythmia termination. As a result, the effector function of an electrical defibrillator would be provided by the heart itself, and therefore no longer rely on electronics, but on bioelectricity instead.

Purpose

To develop a hybrid bio-electronic system for automated and acute shock-free AF treatment.

Methods

To equip the heart with the effector function of the envisioned AF termination system, adeno-associated virus (AAV) vectors encoding red-activatable channelrhodopsin (ReaChR) (n=12) or citrine (n=4) were delivered locally to the right atrium (RA) of adult Wistar rats by gene painting. Four to 8 weeks later, AF was induced in vivo by atrial burst pacing after carbachol administration, followed by programmed local illumination of the RA by an implanted intrathoracic LED device whose activation was automatically regulated by an electrocardiogram (ECG)-based cardiac rhythm monitor.

Results

Gene painting of the RA resulted in transmural transduction of right atrial myocytes (78±6%) with minimum transgene expression of the left atrium and ventricles (6±2% and <0.5%, respectively). Electrophysiological assessments revealed no significant differences in ECG characteristics, atrial action potential duration and conduction velocity when compared to baseline or citrine control animals. Feasibility of optical AF termination was first assessed in an open-chest rat model, showing that a single 470-nm light pulse (3.5 mW/mm2, 1000 ms) efficiently terminated AF in all ReaChR-expressing rats with an average termination efficacy of 94±3% (n=12) vs. 3±3% (n=4) in citrine-expressing control animals (p<0.01). AF termination efficacy remained superb following automated detection and termination of AF by ECG-triggered activation of the implanted intra-thoracic LED in closed-chest ReaChR-expressing rats (96±4%), n=4), whereas none of the AF episodes were terminated in control rats (0%, n=4) (p<0.01). No bradycardias or other arrhythmias were observed following optical AF termination.

Conclusions

By using a hybrid bio-electronic approach to modulate cardiac excitability, our study delivers proof that AF can be detected and terminated automatically in a safe, effective and repetitive, yet shock-free manner. These findings may create the basis for the development of pain-free device therapy for cardiac arrhythmias, thereby paving the way for ambulatory AF treatment with the perspective to improve patients' prognosis and quality of life.

Acknowledgement/Funding

NWO Vidi grant (1714336) and ERC Starting Grant (716509) both to D.A.P.

Effects of Conformal Nanoscale Coatings on Thermal Performance of Vertically Aligned Carbon Nanotubes

The high aspect ratio and the porous nature of spatially oriented forest-like carbon nanotube (CNT) structures represent a unique opportunity to engineer a novel class of nanoscale assemblies. By combining CNTs and conformal coatings, a 3D lightweight scaffold with tailored behavior can be achieved. The effect of nanoscale coatings, aluminum oxide (Al₂ O₃ ) and nonstoichiometric amorphous silicon carbide (a-SiC), on the thermal transport efficiency of high aspect ratio vertically aligned CNTs, is reported herein. The thermal performance of the CNT-based nanostructure strongly depends on the achieved porosity, the coating material and its infiltration within the nanotube network. An unprecedented enhancement in terms of effective thermal conductivity in a-SiC coated CNTs has been obtained: 181% compared to the as-grown CNTs and Al₂ O₃ coated CNTs. Furthermore, the integration of coated high aspect ratio CNTs in an epoxy molding compound demonstrates that, next to the required thermal conductivity, the mechanical compliance for thermal interface applications can also be achieved through coating infiltration into foam-like CNT forests.

Stretchable Binary Fresnel Lens for Focus Tuning

This paper presents a tuneable binary amplitude Fresnel lens produced by wafer-level microfabrication. The Fresnel lens is fabricated by encapsulating lithographically defined vertically aligned carbon nanotube (CNT) bundles inside a polydimethyl-siloxane (PDMS) layer. The composite lens material combines the excellent optical absorption properties of the CNT with the transparency and stretchability of the PDMS. By stretching the elastomeric composite in radial direction, the lens focal length is tuned. Good focusing response is demonstrated and a large focus change (≥24%) was achieved by stretching lenses up to 11.4%.

Thermal characterization of carbon nanotube foam using MEMS microhotplates and thermographic analysis

Thermal material properties play a fundamental role in the thermal management of microelectronic systems. The porous nature of carbon nanotube (CNT) arrays results in a very high surface area to volume ratio, which makes the material attractive for surface driven heat transfer mechanisms. Here, we report on the heat transfer performance of lithographically defined micropins made of carbon nanotube (CNT) nanofoam, directly grown on microhotplates (MHPs). The MHP is used as an in situ characterization platform with controllable hot-spot and integrated temperature sensor. Under natural convection, and equivalent power supplied, we measured a significant reduction in hot-spot temperature when augmenting the MHP surface with CNT micropins. In particular, a strong enhancement of convective and radiative heat transfer towards the surrounding environment is recorded, due to the high aspect ratio and the foam-like morphology of the patterned CNTs. By combining electrical characterizations with high-resolution thermographic microscopy analysis, we quantified the heat losses induced by the integrated CNT nanofoams and we found a unique temperature dependency of the equivalent convective heat transfer coefficient, Hc. The obtained results with the proposed non-destructive characterization method demonstrate that significant improvements can be achieved in microelectronic thermal management and hierarchical structured porous material characterization.