Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.M.P., A.M.S., C.L., V.R.V., C.J.M., S.J.A., S.K.).
Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia (D.M.P.).
Circ Arrhythm Electrophysiol. 2019 Mar;12(3):e006920. doi: 10.1161/CIRCEP.118.006920.
Reentrant ventricular arrhythmias are a major cause of sudden death in patients with structural heart disease. Current treatments focus on electrically homogenizing regions of scar contributing to ventricular arrhythmia with ablation or altering conductive properties using antiarrhythmic drugs. The high conductivity of carbon nanotubes may allow restoration of conduction in regions where impaired electrical conduction results in functional abnormalities. We propose a new concept for arrhythmia treatment using a stretchable, flexible biopatch with conductive properties to attempt to restore conduction across regions in which activation is disrupted.
Carbon nanotube patches composed of nanofibrillated cellulose/single-walled carbon nanotube ink 3-dimensionally printed in conductive patterns onto bacterial nanocellulose were developed and evaluated for conductivity, flexibility, and mechanical properties. The patches were applied on 6 canines to epicardium before and after surgical disruption. Electroanatomic mapping was performed on normal epicardium, then repeated over surgically disrupted epicardium, and then finally with the patch applied passively.
We developed a 3-dimensional printable carbon nanotube ink complexed on bacterial nanocellulose that was (1) expressable through 3-dimensional printer nozzles, (2) electrically conductive, (3) flexible, and (4) stretchable. Six canines underwent thoracotomy, and, during epicardial ventricular pacing, mapping was performed. We demonstrated disruption of conduction after surgical incision in all 6 canines based on activation mapping. The patch resulted in restored conduction based on mapping and assessment of conduction direction and velocities in all canines.
We have demonstrated 3-dimensional custom-printed electrically conductive carbon nanotube patches can be surgically manipulated to improve cardiac conduction when passively applied to surgically disrupted epicardial myocardium in canines.
折返性室性心律失常是结构性心脏病患者猝死的主要原因。目前的治疗方法侧重于通过消融使导致室性心律失常的瘢痕区域去极化，或者使用抗心律失常药物改变传导特性。碳纳米管的高导电性可能允许在电传导受损导致功能异常的区域恢复传导。我们提出了一种使用具有导电性的可拉伸、灵活的生物贴片治疗心律失常的新概念，试图在激活受到干扰的区域恢复传导。
制备了由纳米原纤化纤维素/单壁碳纳米管墨水 3 维打印成导电图案的碳纳米管贴片，并将其应用于细菌纳米纤维素上，以评估其导电性、柔韧性和机械性能。在 6 只犬的心脏外膜上，在手术破坏前后应用贴片。在正常心脏外膜上进行电生理标测，然后在手术破坏的心脏外膜上重复进行，最后被动地应用贴片。
我们开发了一种 3 维可打印的碳纳米管墨水复合物，结合在细菌纳米纤维素上，其特点是：（1）可通过 3 维打印机喷嘴表达；（2）具有导电性；（3）柔软；（4）可拉伸。6 只犬接受了开胸手术，在心脏外膜心室起搏期间进行了标测。我们在所有 6 只犬中都证明了手术切口后传导的中断，这是基于激活标测。在所有犬中，贴片的应用都导致了基于标测的传导恢复，并评估了传导的方向和速度。
我们已经证明，当在犬科动物的心脏外膜心肌手术破坏后被动应用时，3 维定制打印的导电碳纳米管贴片可以通过手术操作来改善心脏传导。
