title: Electromechanical cardioplasty using a wrapped elasto-conductive epicardial mesh.
abstract: Heart failure remains a major public health concern with a 5-year mortality rate higher than that of most cancers. Myocardial disease in heart failure is frequently accompanied by impairment of the specialized electrical conduction system and myocardium. We introduce an epicardial mesh made of electrically conductive and mechanically elastic material, to resemble the innate cardiac tissue and confer cardiac conduction system function, to enable electromechanical cardioplasty. Our epicardium-like substrate mechanically integrated with the heart and acted as a structural element of cardiac chambers. The epicardial device was designed with elastic properties nearly identical to the epicardial tissue itself and was able to detect electrical signals reliably on the moving rat heart without impeding diastolic function 8 weeks after induced myocardial infarction. Synchronized electrical stimulation over the ventricles by the epicardial mesh with the high conductivity of 11,210 S/cm shortened total ventricular activation time, reduced inherent wall stress, and improved several measures of systolic function including increases of 51% in fractional shortening, ~90% in radial strain, and 42% in contractility. The epicardial mesh was also capable of delivering an electrical shock to terminate a ventricular tachyarrhythmia in rodents. Electromechanical cardioplasty using an epicardial mesh is a new pathway toward reconstruction of the cardiac tissue and its specialized functions.
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Gyeonggi-do 16229, Republic of Korea.
authors.forename: Jinkyung
authors.initials: J
authors.lastname: Park
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
authors.forename: Suji
authors.initials: S
authors.lastname: Choi
authors.affiliation: Division of Cardiac Electrophysiology, Health First Medical Group, Cocoa Beach, FL 32931, USA.
authors.forename: Ajit H
authors.initials: AH
authors.lastname: Janardhan
authors.affiliation: Yonsei Cardiovascular Research Center and Cardiovascular Research Institute, Severance Hospital, Yonsei University Health System, Seoul 03722, Republic of Korea. Institute for Biomedical Convergence, College of Medicine, Catholic Kwandong University, Gangneung-si, Gangwon-do 25601, Republic of Korea.
authors.forename: Se-Yeon
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX 78712, USA.
authors.forename: Samarth
authors.initials: S
authors.lastname: Raut
authors.affiliation: Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX 78712, USA.
authors.forename: Joao
authors.initials: J
authors.lastname: Soares
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
authors.forename: Kwangsoo
authors.initials: K
authors.lastname: Shin
authors.affiliation: Center for Mechanics of Solids, Structures and Materials, Department of Aerospace Engineering and Engineering Mechanics, Texas Materials Institute, University of Texas at Austin, Austin, TX 78712, USA.
authors.forename: Shixuan
authors.initials: S
authors.lastname: Yang
authors.affiliation: School of Electrical and Electronic Engineering, Yonsei University, Seoul 03722, Republic of Korea.
authors.forename: Chungkeun
authors.initials: C
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon 35233, Republic of Korea.
authors.forename: Ki-Woon
authors.initials: KW
authors.lastname: Kang
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
authors.forename: Hye Rim
authors.initials: HR
authors.lastname: Cho
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
authors.forename: Seok Joo
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
authors.forename: Pilseon
authors.initials: P
authors.lastname: Seo
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
authors.forename: Wonji
authors.initials: W
authors.lastname: Hyun
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea.
authors.forename: Sungmook
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University Health System, Seoul 03722, Republic of Korea.
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: School of Advanced Materials Engineering, Kookmin University, Seoul 02707, Republic of Korea.
authors.forename: Nohyun
authors.initials: N
authors.lastname: Lee
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX 78712, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Sacks
authors.affiliation: Center for Mechanics of Solids, Structures and Materials, Department of Aerospace Engineering and Engineering Mechanics, Texas Materials Institute, University of Texas at Austin, Austin, TX 78712, USA. State Key Laboratory of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
authors.forename: Nanshu
authors.initials: N
authors.lastname: Lu
authors.affiliation: Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Gyeonggi-do 16229, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea. hhwang@bidmc.harvard.edu dkim98@snu.ac.kr thyeon@snu.ac.kr.
authors.forename: Taeghwan
authors.initials: T
authors.lastname: Hyeon
authors.affiliation: Center for Nanoparticle Research, Institute for Basic Science, Seoul 08826, Republic of Korea. School of Chemical and Biological Engineering, Institute of Chemical Processes, Seoul National University, Seoul 08826, Republic of Korea. hhwang@bidmc.harvard.edu dkim98@snu.ac.kr thyeon@snu.ac.kr.
authors.forename: Dae-Hyeong
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Yonsei Cardiovascular Research Center and Cardiovascular Research Institute, Severance Hospital, Yonsei University Health System, Seoul 03722, Republic of Korea. hhwang@bidmc.harvard.edu dkim98@snu.ac.kr thyeon@snu.ac.kr.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Hwang
mesh_terms: D000818:Animals; D009202:Cardiomyopathies / Q000503:physiopathology / Q000601:surgery; D004553:Electric Conductivity; D006329:Heart Conduction System / Q000601:surgery*; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery; D017207:Rats, Sprague-Dawley; D013526:Surgical Mesh