There is an urgent clinical need for a treatment regimen that addresses the underlying pathophysiology of ventricular arrhythmias, the leading cause of sudden cardiac death. The current report describes the design of an injectable hydrogel electrode and successful deployment in a pig model with access far more refined than any current pacing modalities allow. In addition to successful cardiac capture and pacing, analysis of surface ECG tracings and three-dimensional electroanatomic mapping revealed a QRS morphology comparable to native sinus rhythm, strongly suggesting the hydrogel electrode captures the deep septal bundle branches and Purkinje fibers. In an ablation model, electroanatomic mapping data demonstrated that the activation wavefront from the hydrogel reaches the mid-myocardium and endocardium much earlier than current single-point pacing modalities. Such uniform activation of broad swaths of tissue enables an opportunity to minimize the delayed myocardial conduction of heterogeneous tissue that underpins re-entry. Collectively, these studies demonstrate the feasibility of a new pacing modality that most closely resembles native conduction with the potential to eliminate lethal re-entrant arrhythmias and provide painless defibrillation.

临床迫切需要一种治疗方案来解决室性心律失常的潜在病理生理学问题，室性心律失常是心源性猝死的主要原因。当前的报告描述了可注射水凝胶电极的设计以及在猪模型中的成功部署，其访问比任何当前起搏方式都更加精细。除了成功的心脏捕获和起搏之外，表面心电图描记和三维电解剖图分析还揭示了与自然窦性心律相当的 QRS 形态，强烈表明水凝胶电极捕获了深部间隔束支和浦肯野纤维。在消融模型中，电解剖图数据表明，水凝胶的激活波前比当前的单点起搏方式更早到达心肌中部和心内膜。这种大范围组织的均匀激活使得有机会最大限度地减少支撑再入的异质组织的延迟心肌传导。总的来说，这些研究证明了一种与自然传导最相似的新起搏方式的可行性，有可能消除致命的折返性心律失常并提供无痛除颤。