Innovative solutions for sustainable healthcare
Medical Delta
Medical Delta, location YES!Delft Labs
Molengraaffsingel 10
2629 JD Delft
The Netherlands
info@medicaldelta.nl
+31 (0)6 2492 8919
A heart that can recognize and correct a dangerous heart rhythm disorder on its own, without a painful electric shock. It may sound like science fiction, but researchers at LUMC and TU Delft are already working on it. Their revolutionary approach brings biology and technology together and could transform the treatment of heart rhythm disorders forever.
This article was previously published on the LUMC website.
Many cardiac arrhythmias can be treated with medication or ablation. However, these treatments do not work equally well for all patients. One example is atrial fibrillation, the most common cardiac arrhythmia in the Netherlands: approximately 300,000 people are affected by it.
For this group of patients, an electric shock is sometimes the only way to restore a normal heart rhythm. This procedure is called electrical cardioversion. “The heart is given a powerful electric shock that resets the rhythm. But because people remain conscious during the arrhythmia, such a shock would be very painful and burdensome for patients,” says LUMC Professor of Cellular Electrophysiology Daniël Pijnappels. Pijnappels is also a Medical Delta professor with a joint appointment at Delft University of Technology. “That is why they have to go to the hospital each time to undergo cardioversion under general anesthesia.”
People with atrial fibrillation cannot receive an ICD either, a device that delivers a shock when dangerous cardiac arrhythmias occur while a person is awake.
Our heart continuously produces electrical signals. Doctors currently use these signals only to make a diagnosis, for example with an ECG. “We want to use the electrical signals that the heart naturally produces to stop the arrhythmia itself,” says Pijnappels.
The solution the team is developing for this group of patients, among others, is technical, but according to Pijnappels also “surprisingly logical.” “The heart functions through electrical signals. By controlling these signals, you can influence the heart rhythm and allow the heart to defibrillate itself,” he says.
The team has developed this idea into a biologically integrated cardiac defibrillator: the BioICD.
The BioICD is equipped with LED lights that use flashes of light to generate the electrical signals needed to influence and restore the heart rhythm. To make this possible, the heart must first be able to do something it cannot naturally do: respond electrically to light. Gene therapy can be used to introduce special proteins into heart cells that are capable of doing this. When light falls on the cell, these proteins produce a small electrical signal. “This allows us to precisely control where, when, and for how long a heart cell produces a certain amount of electrical current,” explains Pijnappels. “This is how we are learning how much electrical stimulation is needed to stop an arrhythmia.”
But a heart that responds to light also needs a light source that can be activated at exactly the right time and in exactly the right place. This is where the collaboration between LUMC and TU Delft comes in. Together, they have developed small, smart LED systems that can be implanted deep inside the body and deliver precisely the right amount of light at the right moment.
“We can implant these LED systems in animals,” says the professor. “We have now demonstrated the principle in rats. The next step is to conduct research in pigs.” The technology is not yet ready for use in humans, but according to Pijnappels, the prospects are very promising.
To investigate how a flash of light can stop an arrhythmia, the researchers first need to understand exactly how heart cells respond. They cannot simply test this in humans either. That is why they use a safe intermediate step: a kind of artificial heart made from real human tissue grown in the laboratory.
For this purpose, the researchers take actual human heart cells and grow them in a large dish into a layer of tissue. This layer is approximately the same size as the atrial tissue in a real human heart. “Size matters when it comes to arrhythmias,” says Pijnappels. “Heart cells behave differently in a small piece of tissue than they do in a full-size model.”
In this model, the researchers can induce arrhythmias, test different light patterns, and observe how the heart rhythm changes when the LED lights are activated.
The heart cells used by LUMC come from donated heart tissue. Associate Professor Twan de Vries works in the laboratory on developing and growing these cells. This allows the cells to be used repeatedly for research. In science, this is known as a cell line. As a result, LUMC has unique human cell lines that may be of interest for both academic and commercial research.
Meanwhile, the researchers have also been exploring ways to activate the LED system when an arrhythmia occurs. This led to the idea of a smartwatch that detects an arrhythmia and sends a signal to a small receiver under the skin. The receiver would then activate the small, smart LED system on the heart.
“You place your smartwatch on your chest, and your heart restores its own rhythm. Without you feeling any pain,” says Pijnappels, placing his wrist against his chest as he speaks. It sounds futuristic, and such a smartwatch does not exist yet. Before this kind of technology can ever be used in humans, extensive testing will be required.
The BioICD also still needs to undergo further testing, refinement, and validation. The technology is still developing. But if everything goes according to plan, this approach could fundamentally change the treatment of cardiac arrhythmias. “The ultimate goal is to enable the heart itself to detect and stop an arrhythmia. Without electronics or light, but entirely biological and shock-free. The heart as its own defibrillator,” says Pijnappels.
The heart is a complex organ in which biology, physics, chemistry, engineering, and medicine come together. That is why doctors, biologists, engineers, physicists, and analysts work together in the Laboratory of Experimental Cardiology, led by Pijnappels.
The laboratory is designed so that different types of research can literally take place side by side: from pipetting to simulation and soldering. This allows researchers and students from different disciplines to work together and learn from one another. “Our goal is to bring biology and technology together so that we can better understand and treat heart disease,” says Pijnappels.
Among other things, the team aims to understand what goes wrong during a cardiac arrhythmia and develop innovative solutions to address it.
Also read: A heart that can defibrillate itself: LUMC and TU Delft work towards a shock-free future | LUMC
Innovative solutions for sustainable healthcare
Medical Delta, location YES!Delft Labs
Molengraaffsingel 10
2629 JD Delft
The Netherlands
info@medicaldelta.nl
+31 (0)6 2492 8919