Injectable hydrogel electrodes open door to a novel painless treatment regimen for arrhythmia

HOUSTON (Jan 9, 2024)— A breakthrough study led by Dr. Mehdi Razavi at The Texas Heart Institute (THI), in collaboration with a biomedical engineering team of The University of Texas at Austin (UT Austin) Cockrell School of Engineering led by Dr. Elizabeth Cosgriff-Hernandez, sets the foundation of a ground-breaking treatment regimen for treating ventricular arrhythmia.  Their study published in Nature Communications demonstrates the design and feasibility of a new hydrogel-based pacing modality.

The urgent need for an effective therapeutic regimen for ventricular arrhythmia inspired THI's Electrophysiology Clinical Research & Innovations (EPCRI) team, led by its director, Dr. Razavi, to partner with Dr. Cosgriff-Hernandez and her UT Austin Biomedical Engineering (UT Austin BME) team to co-develop an innovative strategy that addresses the pathophysiology of re-entrant arrhythmia.

Ventricular arrhythmia, which occurs in the lower chambers of the heart or ventricles, is the leading cause of sudden cardiac death in the United States. When heart rhythm abnormality occurs in a self-sustained manner, it is called re-entrant arrhythmia, which is usually fatal.

“Re-entry occurs mainly from delayed conduction in scarred heart tissues, usually after coronary artery occlusion during a heart attack, which can be corrected by enabling pacing in these regions,” said Dr. Razavi, a practicing cardiologist and cardiac electrophysiologist. “These hydrogels then can access the scarred tissue, thereby enabling direct pacing of the otherwise inaccessible regions of the heart.”

Given hydrogels' biostability, biocompatibility, tunable properties, and the ease of incorporating electrical conductivity, the scientists are exploring them as potential electrodes that can be easily delivered inside coronary veins.  A clinical advantage of the unique system is that ischemia can be avoided by delivering the hydrogel using the veins.

The researchers successfully deployed the innovative hydrogel technology through minimally invasive catheter delivery in a pig model.

“The hydrogels have significant conductive properties that enable simultaneous pacing from multiple sites along the length of the hydrogel and create a conduction highway similar to those in Purkinje fibers,” according to Dr. Cosgriff-Hernandez.

Today, arrhythmia is treatable with medicines and procedures that control the irregular rhythms. The current anti-arrhythmic drugs on the market are not always effective; although the drugs slow the conduction velocity, they facilitate re-entry arrhythmia. Moreover, these drugs can be toxic and can lead to the destruction of tissues near the diseased regions of the heart. Even with the widely used interventional ablation therapies, arrhythmia recurs in a significant proportion of patients. None of these procedures address the mechanism of re-entry.

Cardiac defibrillators implanted to compensate for the shortfalls in the current therapy options are painful when delivering electric shocks to restore heart rhythm and can severely deteriorate the patient’s quality of life. If left untreated, arrhythmia can damage the heart, brain, or other organs, leading to stroke or cardiac arrest, during which the heart suddenly and unexpectedly stops beating.

“When injected into target vessels, the conductive hydrogel conforms to the patient’s vessel morphology. Adding a traditional pacemaker to this gel allows for pacing that resembles the native conduction in the heart – effectively mimicking the native electrical rhythm of the heart – and extinguishes the cause for arrhythmia, providing painless defibrillation,” added Dr. Cosgriff-Hernandez.

The work demonstrates for the first time the ability to confer direct electrical stimulation of the native and scarred mid-myocardium through injectable hydrogel electrodes as a pacing modality.

With minimally invasive catheter delivery and standard pacemaker technologies, this study indicates the feasibility of a novel pacing modality that resembles native conduction, potentially eliminating lethal re-entrant arrhythmia and providing painless defibrillation, which can be successfully adopted in a clinical workflow.

The scientific advance is significant considering pain management is highly relevant to overall wellness for patients with heart, lung, and blood diseases. Such innovation in painless defibrillation and preventing arrhythmia could revolutionize cardiac rhythm management.

Funding was provided by the National Heart, Lung, and Blood Institute of the National Institutes of Health (R01 HL162741); Ford Pre-Doctoral Fellowship, administered by the National Academy of Science, Engineering and Medicine; Ford Dissertation Fellowship, administered by the National Academy of Science, Engineering and Medicine; Office of Vice President for Research, The University of Texas at Austin; The Roderick D. MacDonald Research Fund Award 19RDM004; and The Sultan Qaboos Chair in Cardiology at the St. Luke’s Foundation.

The content of this research is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Rodriguez-Rivera, G.J., Post, A., John, M., Buchan, S., Bernard, D., Razavi, M., Cosgriff-Hernandez, E. Injectable hydrogel electrodes as conduction highways to restore native pacing. Nat Commun 15, 64 (2024). doi: 10.1038/s41467-023-44419-0

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About The Texas Heart Institute

The Texas Heart Institute (THI) is an independent, nonprofit organization with the mission of improving cardiovascular health today through trailblazing research, thought leadership, education, and patient care. Located within the Texas Medical Center in Houston, Texas, and founded in 1962 by renowned cardiac surgeon Dr. Denton Cooley, THI performed the first successful heart transplant and total artificial heart implant in the United States. Since then, its physicians and surgeons have remained recognized as worldwide leaders in diagnosing and treating even the most complex cardiovascular conditions. Research programs at THI continue pushing cardiovascular science's boundaries by translating laboratory discovery into patient care. THI has been ranked among the top cardiovascular centers in the United States by US News & World Report for over 30 years. www.texasheart.org
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About The University of Texas at Austin

The University of Texas at Austin (UTA), founded in 1883, ranks among the 40 best universities in the world. The university supports some 52,000 diverse students, 3,000 teaching faculty, and top national programs across 19 colleges and schools. Amid the backdrop of Austin, Texas, a city recognized for its creative and entrepreneurial spirit, the university provides a place to explore countless opportunities for tomorrow's artists, scientists, athletes, doctors, entrepreneurs, and engineers. The mission of UTA is to achieve excellence in the interrelated areas of undergraduate education, graduate education, research, and public service. The university provides superior and comprehensive educational opportunities at the baccalaureate through doctoral and special professional academic levels. The university contributes to the advancement of society through research, creative activity, scholarly inquiry, and the development and dissemination of new knowledge, including the commercialization of its discoveries. www.utexas.edu