The Swiss approach for a heartbeat-driven lead- and batteryless pacemaker

Zurbuchen, Adrian; Haeberlin, Andreas; Bereuter, Lukas; Wagner, Joerg; Pfenniger, Aloïs; Omari, Sammy; Schaerer, Jakob; Jutzi, Frank; Huber, Christoph; Fuhrer, Juerg; Vogel, Rolf

doi:10.1016/j.hrthm.2016.10.016

Cited by 41 publications

(24 citation statements)

References 30 publications

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“…It was shown in a pre-clinical study that lead-and batteryless pacing was feasible using its own heart motion. 25 In another pre-clinical study, a batteryless PM was developed that was powered by a solar module that converted transcutaneous light into electrical energy. 26 This PM was able to provide pacing therapy continuously at a rate of 125 BPM for 1.5 months in the dark.…”

Section: Recommendations and Perspectivesmentioning

confidence: 99%

End-of-life Management of Leadless Cardiac Pacemaker Therapy

Beurskens

Tjong

Knops

2017

Arrhythmia &Amp; Electrophysiology Review

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DevicesAccess at: www.AERjournal.com Despite these promising results, there is an important challenge to consider: the end-of-life (EOL) management of LP therapy. The optimal approach at the end of service of conventional transvenous PM therapy has been studied in great detail. 7,8 The subcutaneous generator is readily accessible for replacement, leaving the leads in place. 7 PM lead extraction can be a high-risk procedure and is associated with serious complications, including cardiac perforation and death. 8 Up to three leads can be placed intracardially, without haemodynamic compromise. 7 Optimal EOL strategy of LP therapy is subject to debate. The estimated battery longevity of the LP ranges between 4.7 and 15 years, depending on pacing parameters. 2,3,9 Therefore, selected patients might require multiple devices over their lifespan. Once the EOL of the LP approaches, there are two options for implanting physicians to address this problem.LPs were designed so that they can be programmed in a non-functional mode. The LP can be abandoned and an additional device may be implanted adjacent to the non-functional LP. Important concerns have been raised regarding the aforementioned option. Multiple devices in the heart may compromise cardiac function, or be a source of interference. The second replacement strategy is to extract the LP and subsequently implant a new device. However, extraction may not be feasible due to encapsulation of the device, and this will probably be more prevalent with more chronic use of LP therapy. Of note, there are situations where extraction of the LP may be necessary, such as in infection or dislocation. Recently, a battery advisory was distributed by Abbott stating that 7 of 1423 (0.5 %) patients had a battery malfunction that occurred more than two years after Nanostim LCP implantation. This battery dysfunction has not been shown to affect Micra TPS.With the battery advisory and the more chronic use of LPs, recommendations for EOL management become increasingly important. Therefore, an up-to-date review of available evidence on retrieval of LPs is highly clinically relevant. In this review we describe the safety, feasibility and histopathological examination of LP retrieval. Leadless Pacemaker and Retrieval SystemsBoth LPs are cylindrical intracardiac devices; however, there are differences in design that merit emphasis. The Nanostim LCP is 42 mm long and 5.99 mm in diameter, whereas the Micra TPS measures AbstractThe clinically available leadless pacemakers for patients with a single-chamber pacing indication have shown to be safe and effective.However, the optimal end-of-life strategy of this novel technique is undefined. Suggested strategies comprise of (a) placing an additional leadless device adjacent to the leadless pacemaker, or (b) retrieving the non-functioning leadless pacemaker and subsequently implanting a new device. Although initial studies demonstrate promising results, early experience of acute and mid-term retrieval feasibility and safety remains mixed. We suggest th...

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Section: Recommendations and Perspectivesmentioning

confidence: 99%

End-of-life Management of Leadless Cardiac Pacemaker Therapy

Beurskens

Tjong

Knops

2017

Arrhythmia &Amp; Electrophysiology Review

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“…Zurbuchen et al recently conducted an in vivo study on pig's heart for 30 min. [18] Their study aimed at demonstration of battery and leadless cardiac pacing by using energy harvesting mechanism derived from Swiss wristwatch. It was shown that the mechanism generated sufficient electrical power (<10 µW) to meet out the demand of a typical modern pacemaker.…”

Section: Doi: 101002/gch2201700084mentioning

confidence: 99%

A Comparative Numerical Study on Piezoelectric Energy Harvester for Self‐Powered Pacemaker Application

et al. 2017

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The potential application of this energy harvesting has been recognized in the form of the replacement of batteries of the pacemakers. Since the Ni-Cd or Li-ion batteries used for pacemakers have finite life span [15] and hence these require replacement after a certain period. To overcome this drawback, researchers have been exploring methods where an energy harvester could scavenge energy from human body and power the pacemaker.Goto et al. [16] carried out the pioneering work in the field of powering leadless pacemakers. A kinetic watch energy generating system was employed on a dog's heart and 13 µJ of energy per heartbeat was successfully achieved. Tashiro et al. conducted an experiment where pacemaker was powered by harvesting enough energy from the motion of canine heart. [17] However, the design proposed by them is practically impossible to be placed inside the thoracic cavity of the laboratory animal. Recently, Karami and Inman [12] have proposed zig-zag structures to achieve lower frequencies with piezoceramics to power pacemaker implanted in chest. Heart beat acceleration was used in this study for actuating the harvester but the size of harvester is too large to be inserted into intravenous cavity. Zurbuchen et al. recently conducted an in vivo study on pig's heart for 30 min. [18] Their study aimed at demonstration of battery and leadless cardiac pacing by using energy harvesting mechanism derived from Swiss wristwatch. It was shown that the mechanism generated sufficient electrical power (<10 µW) to meet out the demand of a typical modern pacemaker. [19] A number of researchers have carried out research in this field where piezoelectric energy harvester has been employed to power pacemaker. An exhaustive literature review regarding piezoelectric energy harvesting for pacemaker application along with limitations has been presented in Table 1.The size of miniaturized leadless pacemaker should be such that it can be directly placed inside the heart. [25] So, the size of the pacemaker should be compatible with intravenous introduction, that is, its diameter should be around 6 mm. However, most of the designs proposed so far [20][21][22]12] have dimensions more than that of intravenous cavity hence very impractical from pacemaker design point of view. To the best of authors' knowledge, there is hardly any literature available dealing with the design and study of the energy harvesting systems

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“…[ 18–21 ] Engineering approaches have been explored for various EH mechanisms. In general, there are five major reported cardiac EH approaches: piezoelectric, [ 10–15 ] triboelectric, [ 16,22 ] mass imbalance oscillation, [ 23 ] electrostatic, [ 24 ] and electromagnetic [ 25 ] EH methods (Table S1, Supporting Information). However, almost all those in vivo cardiac EH strategies require thoracotomies to place the devices directly onto the heart.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a mechanical approach using mass imbalance oscillation has been shown to generate about 82.0 ± 4.4 µW (apical) and 90.1 ± 0.7 µW (basal) of power from a beating heart by fixing a device (diameter 27 mm and height 8.3 mm) directly on a pig's heart. [ 23 ] An electrostatic EH mechanism has also been employed by using a honeycomb type variable capacitor with coil springs; however the device was too large to implant into the thoracic cavity of a laboratory animal. [ 24 ] In addition, an electromagnetic approach using neodymium permanent magnets with a flux density of 1.43 T and an array of copper coils has been tested with a mean power output of 0.78 µW at 84 beats per minute (bpm).…”

Section: Introductionmentioning

confidence: 99%

Multifunctional Pacemaker Lead for Cardiac Energy Harvesting and Pressure Sensing

Dong

Closson

Jin

et al. 2020

Adv Healthcare Materials

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Biomedical self‐sustainable energy generation represents a new frontier of power solution for implantable biomedical devices (IMDs), such as cardiac pacemakers. However, almost all reported cardiac energy harvesting designs have not yet reached the stage of clinical translation. A major bottleneck has been the need of additional surgeries for the placements of these devices. Here, integrated piezoelectric‐based energy harvesting and sensing designs are reported, which can be seamlessly incorporated into existing IMDs for ease of clinical translation. In vitro experiments validate the energy harvesting process by simulating the bending and twisting motion during heart cycle. Clinical translation is demonstrated in four porcine hearts in vivo under various conditions. Energy harvesting strategy utilizes pacemaker leads as a means of reducing the reliance on batteries and demonstrates the charging ability for extending the lifetime of a pacemaker battery by 20%, which provides a promising self‐sustainable energy solution for IMDs. The additional self‐powered blood pressure sensing is discussed, and the reported results demonstrate the potential in alerting arrhythmias by monitoring the right ventricular pressure variations. This combined cardiac energy harvesting and blood pressure sensing strategy provides a multifunctional, transformative while practical power and diagnosis solution for cardiac pacemakers and next generation of IMDs.

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The Swiss approach for a heartbeat-driven lead- and batteryless pacemaker

Cited by 41 publications

References 30 publications

End-of-life Management of Leadless Cardiac Pacemaker Therapy

End-of-life Management of Leadless Cardiac Pacemaker Therapy

A Comparative Numerical Study on Piezoelectric Energy Harvester for Self‐Powered Pacemaker Application

Multifunctional Pacemaker Lead for Cardiac Energy Harvesting and Pressure Sensing

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