title: Totally implantable robot to treat chronic atrial fibrillation.
abstract: Chronic atrial fibrillation affects millions of people worldwide. Its surgical treatment often fails to restore the transport function of the atrium. This study first introduces the concept of an atrial assist device (AAD) to restore the pump function of the atrium. The AAD is developed to be totally implantable in the human body with a transcutaneous energy transfer system to recharge the implanted battery. The ADD consists of a motorless pump based on artificial muscle technology, positioned on the external surface of the atrium to compress it and restore its muscular activity. A bench model reproduces the function of a fibrillating atrium to assess the circulatory support that this pump can provide. Atripump (Nanopowers SA, Switzerland) is a dome-shaped silicone-coated nitinol actuator 5 mm high, sutured on the external surface of the atrium. A pacemaker-like control unit drives the actuator that compresses the atrium, providing the mechanical support to the blood circulation. Electrical characteristics: the system is composed of one actuator that needs a minimal tension of 15 V and has a maximum current of 1.5 A with a 50% duty cycle. The implantable rechargeable battery is made of a cell having the following specifications: nominal tension of a cell: 4.1 V, tension after 90% of discharge: 3.5 V, nominal capacity of a cell: 163 mA h. The bench model consists of an open circuit made of latex bladder 60 mm in diameter filled with water. The bladder is connected to a vertically positioned tube that is filled to different levels, reproducing changes in cardiac preload. The Atripump is placed on the outer surface of the bladder. Pressure, volume and temperature changes were recorded. The contraction rate was 1 Hz with a power supply of 12 V, 400 mA for 200 ms. Preload ranged from 15 to 21 cm H(2)O. Maximal silicone membrane temperature was 55 degrees C and maximal temperature of the liquid environment was 35 degrees C. The pump produced a maximal work of 16 x 10(-3) J. Maximal volume pumped was 492 ml min(-1). This artificial muscle pump is compact, follows the Starling law and reproduces the hemodynamic performances of a normal atrium. It could represent a new tool to restore the atrial kick in persistent atrial fibrillation.
authors.affiliation: Cardiovascular Surgery Department, CHUV, Lausanne, Switzerland. Piergiorgio.Tozzi@chuv.ch
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Tozzi
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayoz
authors.forename: Pierrick
authors.initials: P
authors.lastname: Thévenaz
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Roulet
authors.forename: Francois
authors.initials: F
authors.lastname: Salchli
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D001281:Atrial Fibrillation / Q000534:rehabilitation* / Q000628:therapy*; D040761:Biomimetic Materials; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006321:Heart / Q000502:physiology*; D006353:Heart-Assist Devices; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology; D019736:Prostheses and Implants; D012371:Robotics / Q000295:instrumentation*