Wishlist
- Better battery life
- Adaptive algorithms for intelligent pacing
- Remote monitoring
- Modular and combination therapies
- Device based monitoring and intervention
Not discussing today
- Optimization of implant and programming
- Improving responder rate
- Improving hardware
Better battery life
Battery advances
- Better battery chemistry
- Energy harvesting technology
- Wireless charging
- Nanotechnology - nanomaterials for electrode surfaces
- Ultra low power electronics
Battery chemistry
- Senning 1958 - Rechargeable Nickel Cadmium battery (hours to 6 weeks)
- 1960s - Mercury Zinc batteries
- Plutonium nuclear power
- Lithium Iodine - 1975
- Lithium Silver Vanadium Oxide - ICDs
- Other Lithium ion batteries
Energy harvesters
Biofuel cell, thermoelectric generator,piezoelectric transducer, triboelectric nano generator
Implantable Triboelectric Nano Generator (ITENG)
Ouyang H, Liu Z, Li N, Shi B, Zou Y, Xie F, Ma Y, Li Z, Li H, Zheng Q, Qu X, Fan Y, Wang ZL, Zhang H, Li Z. Symbiotic cardiac pacemaker. Nat Commun. 2019 Apr 23;10(1):1821. doi: 10.1038/s41467-019-09851-1.
Adaptive algorithms for intelligent pacing
Adaptive pacing
- Rate hysteresis
- Rate responsive pacing
- AV hysteresis
- AF rate modulation
Managed ventricular pacing
Adaptive LV pacing
Better adaptive algorithms?
- Better measures of cardiac function
- Evaluating response to different settings
- In every device
Better remote monitoring
Remote monitoring as standard of care
Boriani G, … Burri H; MORE-CARE Study Investigators. Effects of remote monitoring on clinical outcomes and use of healthcare resources in heart failure patients with biventricular defibrillators: results of the MORE-CARE multicentre randomized controlled trial. Eur J Heart Fail. 2017 Mar;19(3):416-425. doi: 10.1002/ejhf.626.
Towards universal remote monitoring
- Bluetooth based connectivity
- Intelligent analysis of alerts and appropriate action
- Network of connections for alerts
- Challenges of confidentiality and security
Modular and combination therapies
Dual chamber leadless pacemaker
Knops RE, Reddy VY … Aveir DR i2i Study Investigators. A Dual-Chamber Leadless Pacemaker. N Engl J Med. 2023 Jun 22;388(25):2360-2370. doi: 10.1056/NEJMoa2300080.
WISE CRT
Auricchio A., Delnoy P.P., Butter C., et al. and for the Collaborative Study Group : "Feasibility, safety, and short-term outcome of leadless ultrasound-based endocardial left ventricular resynchronization in heart failure patients: results of the Wireless Stimulation Endocardially for CRT (WiSE-CRT) study". Europace 2014; 16: 681
Leadless pacemaker with ICD
Knops RE …; MODULAR ATP Investigators. A Modular Communicative Leadless Pacing-Defibrillator System. N Engl J Med. 2024 May 18. doi: 10.1056/NEJMoa2401807. Epub ahead of print.
Cardiac contractility modulation
Phrenic nerve stimulation for OSA
Device based monitoring and intervention
Impedance monitoring in heart failure
van Veldhuisen DJ… DOT-HF Investigators. Intrathoracic impedance monitoring, audible patient alerts, and outcome in patients with heart failure. Circulation. 2011 Oct 18;124(16):1719-26. doi: 10.1161/CIRCULATIONAHA.111.043042.
CARDIOMEMS
CHAMPION
Givertz MM … CHAMPION Trial Investigators. Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol. 2017 Oct 10;70(15):1875-1886. doi: 10.1016/j.jacc.2017.08.010.
Monitoring alternans
Swerdlow C, Chow T, Das M, Gillis AM, Zhou X, Abeyratne A, Ghanem RN. Intracardiac electrogram T-wave alternans/variability increases before spontaneous ventricular tachyarrhythmias in implantable cardioverter-defibrillator patients: a prospective, multi-center study. Circulation. 2011 Mar 15;123(10):1052-60. doi: 10.1161/CIRCULATIONAHA.110.986364.
Stochastic pacing to ameliorate alternans
Stochastic pacing to ameliorate alternans
Summary
- CIEDs in patients with heart failure has seen tremendous advances
- More advances on the way
- Better longevity, modular devices are on the way