A ray of light for treating cardiac conduction disorders

Implantable cardiac pacemakers have been employed for the treatment of various arrhythmias beginning in the 1950s. Throughout the years, developments in microfabrication technologies, as well as advances in surgical procedures and the understanding of electrophysiology, have brought forth next-generation cardiac pacemakers. These are much smaller, capable of feedback regulation, and endowed with longer-lived batteries, which decrease the need for frequent surgery and battery replacement (1). In addition, the advent of antiinflammatory drug-eluting leads has significantly reduced the risk of inflammation and rejection after cardiac pacemaker implantation. However, these devices do not completely eliminate the immune response (2) and still require battery replacements every several years. Furthermore, implantation of foreign bodies on the heart still poses the risk of fouling in the chest cavity, with resultant unwanted electrochemical reactions. In PNAS, Parameswaran et al. (3) describe the development of an approach for cardiac cell and whole-heart pacing.

Traditional cardiac pacemakers rely on delivering an electrical pulse to the cardiac tissue to elicit a response in the form of cell contraction. This method is based on the depolarization of the membrane potential of the cardiomyocytes, which leads to intracellular calcium release and activation of the cell contraction machinery. Developments in the field of optogenetics have previously shown that by infecting cardiac cells with light-gated ion channels, it is possible to elicit cardiac cell contraction by light illumination (4). While this method is not invasive, it involves infection of the cardiac tissue with a virus expressing the light-activated ion channel. Other noninvasive methods based on light illumination have shown that cardiac cells can be paced without the need to apply an electric field. Gentemann et al. (5) described the use of gold nanoparticles irradiated with a 532-nm laser to induce heating of the cardiac cells, which leads to calcium oscillations and cell contraction …

↵¹To whom correspondence should be addressed. Email: tdvir{at}post.tau.ac.il.