Comparison to prior work on conductive materials
It is important to consider these findings in light of prior data on the
impact of conductive materials on cell-cell interaction in the heart. We
have previously reported data on the use of 3D-printed patches to
restore conduction across disrupted areas of myocardial
activation(12). This has similarly been
demonstrated by others. However, scar and arrhythmogenic circuits are
often multi-dimensional and not simply reflected along a single surface.
Thus, identifying ways to enhance conduction not just along the surface
(whether endocardially or epicardially) but transmurally may be critical
when developing a solution that may be antiarrhythmic. Each will have
theoretical benefits and limitations – a patch may be less invasive,
reversible, and easier to apply with a lower risk of complications due
to lack of need to inject directly into myocardial tissue. However,
injection approaches may more directly address the conduction
heterogeneity attributable to 3-dimensional complexity that is likely
seen in most cases of scar-related arrhythmia.
Furthermore, prior work has suggested that other materials aside from
carbon nanotubes may allow for enhanced conduction between otherwise
electrically disconnected myocytes. We did not directly compare the
effects of our material with these other materials. However, most work
has been on creating a surface over which cells are placed and then
evaluating conduction rather than methods that may facilitate enhanced
conduction transmurally. Determination of the optimal conductive
materials based on chronic maintenance of conduction and
biocompatibility will require further study.