An Ultrasonic Implant for Fighting

Heart Failure

Guided By: Presented By:

1.Mr. Shivathanu .L
Asst. Prof(Dept. of ECE)
Anju K. Thomas
EC 7B
2.Mrs. Revathy Nath H.A Roll no:21
Asst. Prof(Dept. of ECE) CEP
OBJECTIVES

 To understand the technology used to achieve

wireless
pacing based on converting ultrasound energy into
electrical energy.

 To familiarize with the WiSE (Wireless Stimulation of the

Endocardium) technology that enrolled heart failure
patients who hadn’t improved after receiving a traditional
CRT device .
NEED OF NEW TECHNOLOGY
 INTRODUCTION
 Every year about 150,000 patients with heart failure undergo
surgery to have cardiac resynchronization therapy(CRT)
devices implanted.
 These send regular jolts of electricity through their hearts to
keep the chambers pumping in unison.
 However, about 50,000 of those people will receive no
benefit from this invasive and expensive procedure and find
that they have few options left to keep them alive.
 Now, a new device offers hope to these “non-responders.” A
tiny wireless implant controlled by ultrasonic pulses uses a
novel approach to heartbeat maintenance.
An electrode about the size of a grain of rice helps
the heart's chambers beat in sync
UNDERSTANDING HEART FAILURE

Heart failure is a chronic,

progressive condition in which the
heart muscle is unable to pump
enough blood to meet the body's
needs for blood and oxygen.

In left-sided heart failure, the left

side of the heart must work harder to
pump the same amount of blood. The
heart's pumping action moves oxygen-
rich blood as it travels from the lungs
to the left atrium, then on to the left
ventricle, which pumps it to the rest of
the body. The left ventricle supplies
most of the heart's pumping power, so
it is larger than the other chambers
and essential for normal function.
THE “PACEMAKER”
 A pacemaker is a small battery-operated device that helps
the heart to beat in a regular rhythm.

 It does this with a small electric stimulation that helps the

heart to beat regularly. It is hooked up to the heart with
tiny wires.

 Cardiac Resynchronization Therapy (CRT), also known

as biventricular pacing, is a special pacemaker used to
make the ventricles contract at the same time. This helps
the lower heart chambers pump and relax together.
 CRT TODAY
 CRT implants use three electrodes attached by wires, called leads.
Two leads go into the right atrium and right ventricle. The third
lead must stimulate the left ventricle, which sends oxygenated
blood out to the body. But placing a foreign object inside that
chamber is risky. That’s why cardiologists place the third electrode
on the outside of the left ventricle.

 Placing that third lead is tough, because the surgeon must snake it
through a narrow vein that wraps around the outside of the heart.

 Precise placement is important, because patients who have

suffered heart attacks have patches of inert scar tissue on their
hearts, and stimulating the heart at those spots won’t do any good.
WiSE TECHNOLOGY
 The WiSE system comprises three main components, ultrasound transmitter,
battery, and electrode.

 The tiny electrode, about the size of a grain of rice, hooks into the inner wall
of the left ventricle. It is covered by a “little polyester scaffold,” and heart
cells quickly grow over to encapsulate it.

 The electrode doesn’t contain a battery or microprocessor . Inside the

electrode are 47 piezoelectric elements that simply generate an electric charge
when subjected to mechanical stress. And that stress is supplied by focused
ultrasonic waves that hit the electrode in the desired rhythm for the heartbeat.

 EBR Systems, a company in Sunnyvale, California, just received European

regulatory approval to introduce its WiSE technology that works in
conjunction with an existing pacemaker to wirelessly pace the left ventricle
from the inside.
 HOW IT WORKS ?
 The system consists of a pulse generator that is positioned
outside, but next to the heart. A small receiver-electrode is
attached to the endocardium of the left ventricle.

 When the generator detects an electric pulse originating

from the pacemaker’s leads inside the right ventricle, it
immediately matches it with an ultrasound pulse and
initiates an ultrasonic energy pulse.

 The receiver electrode converts the ultrasound energy to

electrical energy at sufficient amplitudes to stimulate
cardiac tissue.
FOR BETTER UNDERSTANDING…
ADVANTAGES OF WiSE
 The WiSE CRT System improve results and reduce complications.

 It provides a more customized and patient-specific solution.

 WIRELESS: Leadless LV Stimulation; designed to eliminate lead

complications.

 ENDOCARDIAL: More Physiological Pacing - delivering improved

electrical and haemodynamic (flow of blood)response

 CUSTOMISED: Freedom in LV Positioning; designed for flexibility in

pacing site selection to customize therapy for the individual
Comparison WiSE system with
conventional CRT
Features Conventional CRT WiSE CRT

Pacing site LV Epicardial Endocardial

Co-implant device NO YES

Wireless pacing NO YES

Lead extraction in case Challenging Not necessary

of device-related
infection
CHALLENGING FACTS
 Feasibility of the device is proved but a very
limited number of treated patients limits the
evaluation.
 WiSE system is a co-implant.
 Short and long term direct measurements of
lead performance indicators cannot be
measured since there is no direct electrical
connection to LV electrode after it is implanted.
FUTURE ADVANCEMENTS
 Modifications to the system, the addition of the fixation
accessory to stabilize the transmitter position and additional
software developments can be made to the WiSE system to
improve both the safety and efficacy.

 Safety and Performance of Electrode Implanted in the Left

Ventricle (SELECT-LV),a study was established to
demonstrate the improvements, assess safety, performance,
and preliminary efficacy and achieve a CE Mark.

 SELECT-LV is a non-randomized, study of CRT indicated

patients with either a failure of conventional CRT device,
untreated or non-responders, or requiring an upgrade .
 CONCLUSION
 Endocardial stimulation rather than conventional epicardial
pacing has been shown to be more physiological,
improving electrical stimulation of the left ventricle, give
less dispersion of repolarisation and result in better
resynchronization.

 The feasibility of the WiSE system has been successfully

demonstrated in a population of failed cardiac
resynchronization patients, where a conventional system
was not an option.

 WiSE is an innovative technology with promising safety,

performance and preliminary efficacy.
 REFERENCES
1. Eliza Strickland ,An ultrasonic implant for fighting heart failure. ieee spectrum
2016 June
2 . Auricchio A et al.,First-in-man implantation of leadless ultrasound-based
cardiac stimulation pacing system:novel endocardial left ventricular
resynchronization therapy in heart failure patients. Europace 2013 May
3. Auricchio A et al.,Feasibility,safety, and short-termoutcome of leadless ultrasound
basedendocardial left ventricular resynchronization in heart failure patients:
resultsof the Wireless Stimulation Endocardially for CRT(WiSE-
CRT)study.Eurospace 2014 May;16(5):681-8

4. Echt et al.,Feasibility and safety of a novel technology for pacing without leads.
Heart Rhythm2006;3:1202-6.
5. Echt DS et al., Chronic implantation of leadless pacing electrode in the left
ventricle of a goat model.Heart Rhythm 2010;S451-2
THANK YOU FOR YOUR
ATTENTION!!