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An epicardial bioelectronic patch made from soft rubbery materials and capable of spatiotemporal mapping of electrophysiological activity


An epicardial bioelectronic patch is an important device for investigating and treating heart diseases. The ideal device should possess cardiac-tissue-like mechanical softness and deformability, and be able to perform spatiotemporal mapping of cardiac conduction characteristics and other physical parameters. However, existing patches constructed from rigid materials with structurally engineered mechanical stretchability still have a hard–soft interface with the epicardium, which can strain cardiac tissue and does not allow for deformation with a beating heart. Alternatively, patches made from intrinsically soft materials lack spatiotemporal mapping or sensing capabilities. Here, we report an epicardial bioelectronic patch that is made from materials matching the mechanical softness of heart tissue and can perform spatiotemporal mapping of electrophysiological activity, as well as strain and temperature sensing. Its capabilities are illustrated on a beating porcine heart. We also show that the patch can provide therapeutic capabilities (electrical pacing and thermal ablation), and that a rubbery mechanoelectrical transducer can harvest energy from heart beats, potentially providing a power source for epicardial devices.

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Fig. 1: Soft rubbery epicardial bioelectronic patch.
Fig. 2: Characteristics of the individual devices on the epicardial bioelectronic patch.
Fig. 3: Validation of the sensing system based on the rubbery transistor.
Fig. 4: Electrophysiological mapping in vivo by the fully rubbery transistor active matrix.
Fig. 5: In vivo validation of the rubbery physical sensors and devices for ablation and harvesting.

Data availability

The data that support the plots within this paper and other findings of this study are available from the corresponding author upon reasonable request.

Code availability

Custom code used to process the data is available from the corresponding author upon reasonable request.


  1. 1.

    Heron, M. & Anderson, R. N. Changes in the Leading Cause of Death: Recent Patterns in Heart Disease and Cancer Mortality Data Brief 254 (NCHS, 2016).

  2. 2.

    Mozaffarian, D. et al. Executive summary: Heart disease and stroke statistics—2016 update. Circulation 133, 447–454 (2016).

    Google Scholar 

  3. 3.

    Mair, H., Jansens, J.-L., Lattouf, O. M., Reichart, B. & Dabritz, S. Epicardial lead implantation techniques for biventricular pacing via left lateral mini-thoracotomy, video-assisted thoracoscopy, and robotic approach. Heart Surg. Forum 6, 412–417 (2003).

  4. 4.

    Costa, R., Scanavacca, M., da Silva, K. R., Martinelli Filho, M. & Carrillo, R. Novel approach to epicardial pacemaker implantation in patients with limited venous access. Heart Rhythm 10, 1646–1652 (2013).

    Google Scholar 

  5. 5.

    Boyle, N. G. & Shivkumar, K. Epicardial interventions in electrophysiology. Circulation 126, 1752–1769 (2012).

    Google Scholar 

  6. 6.

    Cantwell, C. D. et al. Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping. Comput. Biol. Med. 65, 229–242 (2015).

    Google Scholar 

  7. 7.

    Dubois, R. et al. Non-invasive cardiac mapping in clinical practice: application to the ablation of cardiac arrhythmias. J. Electrocardiol. 48, 966–974 (2015).

    Google Scholar 

  8. 8.

    Ershad, F., Sim, K., Thukral, A., Zhang, Y. S. & Yu, C. Invited article: emerging soft bioelectronics for cardiac health diagnosis and treatment. APL Mater. 7, 031301 (2018).

    Google Scholar 

  9. 9.

    Erem, B., Brooks, D. H., van Dam, P. M., Stinstra, J. G. & MacLeod, R. S. Spatiotemporal estimation of activation times of fractionated ECGs on complex heart surfaces. In 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society 5884-5887 (IEEE, 2011).

  10. 10.

    Gu, S. et al. Mapping conduction velocity of early embryonic hearts with a robust fitting algorithm. Biomed. Opt. Express 6, 2138–2157 (2015).

    Google Scholar 

  11. 11.

    Fang, H. et al. Capacitively coupled arrays of multiplexed flexible silicon transistors for long-term cardiac electrophysiology. Nat. Biomed. Eng. 1, 0038 (2017).

    Google Scholar 

  12. 12.

    Viventi, J. et al. A conformal, bio-interfaced class of silicon electronics for mapping cardiac electrophysiology. Sci. Transl. Med. 2, 24ra22 (2010).

    Google Scholar 

  13. 13.

    Kim, D. H. et al. Electronic sensor and actuator webs for large-area complex geometry cardiac mapping and therapy. Proc. Natl Acad. Sci. USA 109, 19910–19915 (2012).

    Google Scholar 

  14. 14.

    Xu, L. et al. 3D multifunctional integumentary membranes for spatiotemporal cardiac measurements and stimulation across the entire epicardium. Nat. Commun. 5, 3329 (2014).

    Google Scholar 

  15. 15.

    Xu, L. et al. Materials and fractal designs for 3D multifunctional integumentary membranes with capabilities in cardiac electrotherapy. Adv. Mater. 27, 1731–1737 (2015).

    Google Scholar 

  16. 16.

    Lee, W. et al. Nonthrombogenic, stretchable, active multielectrode array for electroanatomical mapping. Sci. Adv. 4, eaau2426 (2018).

    Google Scholar 

  17. 17.

    Blakney, A. K., Swartzlander, M. D. & Bryant, S. J. The effects of substrate stiffness on the in vitro activation of macrophages and in vivo host response to poly(ethylene glycol)‐based hydrogels. J. Biomed. Mater. Res. A 100, 1375–1386 (2012).

    Google Scholar 

  18. 18.

    Engler, A. J. et al. Embryonic cardiomyocytes beat best on a matrix with heart-like elasticity: scar-like rigidity inhibits beating. J. Cell Sci. 121, 3794–3802 (2008).

    Google Scholar 

  19. 19.

    Kim, D. H. et al. Epidermal electronics. Science 333, 838–843 (2011).

    Google Scholar 

  20. 20.

    Park, J. et al. Electromechanical cardioplasty using a wrapped elasto-conductive epicardial mesh. Sci. Transl. Med. 8, 344ra386 (2016).

    Google Scholar 

  21. 21.

    Davenport Huyer, L. et al. Highly elastic and moldable polyester biomaterial for cardiac tissue engineering applications. ACS Biomater. Sci. Eng. 2, 780–788 (2016).

    Google Scholar 

  22. 22.

    Kapnisi, M. et al. Auxetic cardiac patches with tunable mechanical and conductive properties toward treating myocardial infarction. Adv. Funct. Mater. 28, 1800618 (2018).

    Google Scholar 

  23. 23.

    Reis, L. A., Chiu, L. L. Y., Feric, N., Fu, L. & Radisic, M. Biomaterials in myocardial tissue engineering. J. Tissue Eng. Regen. Med. 10, 11–28 (2016).

    Google Scholar 

  24. 24.

    Sim, K. et al. Fully rubbery integrated electronics from high effective mobility intrinsically stretchable semiconductors. Sci. Adv. 5, eaav5749 (2019).

    Google Scholar 

  25. 25.

    Kim, H.-J., Thukral, A., Sharma, S. & Yu, C. Biaxially stretchable fully elastic transistors based on rubbery semiconductor nanocomposites. Adv. Mater. Technol. 3, 1800043 (2018).

    Google Scholar 

  26. 26.

    Kim, H.-J., Sim, K., Thukral, A. & Yu, C. Rubbery electronics and sensors from intrinsically stretchable elastomeric composites of semiconductors and conductors. Sci. Adv. 3, e1701114 (2017).

    Google Scholar 

  27. 27.

    Lee, H. et al. Highly stretchable and transparent supercapacitor by Ag–Au core–shell nanowire network with high electrochemical stability. ACS Appl. Mater. Interfaces 8, 15449–15458 (2016).

    Google Scholar 

  28. 28.

    Momtahan, N. et al. Automation of pressure control improves whole porcine heart decellularization. Tissue Eng. C 21, 1148–1161 (2015).

    Google Scholar 

  29. 29.

    Ji, Y. et al. High-performance p-type copper(i) thiocyanate thin film transistors processed from solution at low temperature. Adv. Mater. Interfaces 6, 1900883 (2019).

    Google Scholar 

  30. 30.

    Lenz, J., del Giudice, F., Geisenhof, F. R., Winterer, F. & Weitz, R. T. Vertical, electrolyte-gated organic transistors show continuous operation in the mA cm−2 regime and artificial synaptic behaviour. Nat. Nanotechnol. 14, 579–585 (2019).

    Google Scholar 

  31. 31.

    Kim, S. H., Hong, K., Lee, K. H. & Frisbie, C. D. Performance and stability of aerosol-jet-printed electrolyte-gated transistors based on poly(3-hexylthiophene). ACS Appl. Mater. Interfaces 5, 6580–6585 (2013).

    Google Scholar 

  32. 32.

    Xu, J. et al. Highly stretchable polymer semiconductor films through the nanoconfinement effect. Science 355, 59 (2017).

    Google Scholar 

  33. 33.

    Xu, J. et al. Multi-scale ordering in highly stretchable polymer semiconducting films. Nat. Mater. 18, 594–601 (2019).

    Google Scholar 

  34. 34.

    Oh, J. Y. et al. Stretchable self-healable semiconducting polymer film for active-matrix strain-sensing array. Sci. Adv. 5, eaav3097 (2019).

    Google Scholar 

  35. 35.

    Wang, S. et al. Skin electronics from scalable fabrication of an intrinsically stretchable transistor array. Nature 555, 83 (2018).

    Google Scholar 

  36. 36.

    Nguyen, J. S., Lakkis, N. M., Bobek, J., Goswami, R. & Dokainish, H. Systolic and diastolic myocardial mechanics in patients with cardiac disease and preserved ejection fraction: impact of left ventricular filling pressure. J. Am. Soc. Echocardiogr. 23, 1273–1280 (2010).

    Google Scholar 

  37. 37.

    Howard-Quijano, K. et al. Left ventricular endocardial and epicardial strain changes with apical myocardial ischemia in an open-chest porcine model. Physiol. Rep. 4, e13042 (2016).

    Google Scholar 

  38. 38.

    D’Hooge, J. et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur. J. Echocardiogr. 1, 154–170 (2000).

    Google Scholar 

  39. 39.

    Ferraiuoli, P. et al. Full-field analysis of epicardial strain in an in vitro porcine heart platform. J. Mech. Behav. Biomed. Mater. 91, 294–300 (2019).

    Google Scholar 

  40. 40.

    Fenton, F. H., Gizzi, A., Cherubini, C., Pomella, N. & Filippi, S. Role of temperature on nonlinear cardiac dynamics. Phys. Rev. E 87, 042717 (2013).

    Google Scholar 

  41. 41.

    Lim, H. S. et al. Noninvasive mapping to guide atrial fibrillation ablation. Card. Electrophysiol. Clin. 7, 89–98 (2015).

    Google Scholar 

  42. 42.

    Narayan, S. M. et al. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation) trial. J. Am. Coll. Cardiol. 60, 628–636 (2012).

    Google Scholar 

  43. 43.

    Diederich, C. J. Thermal ablation and high-temperature thermal therapy: overview of technology and clinical implementation. Int. J. Hyperth. 21, 745–753 (2005).

    Google Scholar 

  44. 44.

    Webb, H., Lubner, M. G. & Hinshaw, J. L. Thermal ablation. Semin. Roentgenol. 46, 133–141 (2011).

    Google Scholar 

  45. 45.

    Toprak, A. & Tigli, O. Piezoelectric energy harvesting: state-of-the-art and challenges. Appl. Phys. Rev. 1, 031104 (2014).

    Google Scholar 

  46. 46.

    Wu, C., Wang, A. C., Ding, W., Guo, H. & Wang, Z. L. Triboelectric nanogenerator: a foundation of the energy for the new era. Adv. Energy Mater. 9, 1802906 (2019).

    Google Scholar 

  47. 47.

    Zhang, C. & Wang, Z. L. in Micro Electro Mechanical Systems (ed. Huang, Q.-A.) 1335–1376 (Springer, 2018).

  48. 48.

    Sánchez-Quintana, D., Doblado-Calatrava, M., Cabrera, J. A., Macías, Y. & Saremi, F. Anatomical basis for the cardiac interventional electrophysiologist. Biomed Res. Int. 2015, 547364 (2015).

  49. 49.

    Tang, A. S. L. et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N. Engl. J. Med. 363, 2385–2395 (2010).

    Google Scholar 

  50. 50.

    Jayaprakash, S. Clinical presentations, diagnosis, and management of arrhythmias associated with cardiac tumors. J. Arrhythm. 34, 384–393 (2018).

    Google Scholar 

  51. 51.

    Cheng, L. K. et al. Detailed measurements of gastric electrical activity and their implications on inverse solutions. In 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society 1302–1305 (IEEE, 2009).

  52. 52.

    Ballaro, A., Mundy, A. R., Fry, C. H. & Craggs, M. D. Bladder electrical activity: the elusive electromyogram. BJU Int. 92, 78–84 (2003).

    Google Scholar 

  53. 53.

    Thukral, A., Ershad, F., Enan, N., Rao, Z. & Yu, C. Soft ultrathin silicon electronics for soft neural interfaces: a review of recent advances of soft neural interfaces based on ultrathin silicon. IEEE Nanotechnol. Mag. 12, 21–34 (2018).

    Google Scholar 

  54. 54.

    Baba, T. et al. Early neuropsychological dysfunction in elderly high-risk patients after on-pump and off-pump coronary bypass surgery. J. Anesth. 21, 452–458 (2007).

    Google Scholar 

  55. 55.

    Zhang, H., Iijima, K., Huang, J., Walcott, G. P. & Rogers, J. M. Optical mapping of membrane potential and epicardial deformation in beating hearts. Biophys. J. 111, 438–451 (2016).

    Google Scholar 

  56. 56.

    Dandel, M., Lehmkuhl, H., Knosalla, C., Suramelashvili, N. & Hetzer, R. Strain and strain rate imaging by echocardiography—basic concepts and clinical applicability. Curr. Cardiol. Rev. 5, 133–148 (2009).

    Google Scholar 

  57. 57.

    Aletras, A. H., Balaban, R. S. & Wen, H. High-resolution strain analysis of the human heart with fast-DENSE. J. Magn. Reson. 140, 41–57 (1999).

    Google Scholar 

  58. 58.

    Guill, A. et al. QT interval heterogeneities induced through local epicardial warming/cooling. An experimental study. Rev. Esp. Cardiol. (Engl. Ed.) 67, 993–998 (2014).

    Google Scholar 

  59. 59.

    Kassiri, Z. et al. Combination of tumor necrosis factor-α ablation and matrix metalloproteinase inhibition prevents heart failure after pressure overload in tissue inhibitor of metalloproteinase-3 knock-out mice. Circ. Res. 97, 380–390 (2005).

    Google Scholar 

  60. 60.

    Skonieczki, B. D., Wells, C., Wasser, E. J. & Dupuy, D. E. Radiofrequency and microwave tumor ablation in patients with implanted cardiac devices: is it safe? Eur. J. Radiol. 79, 343–346 (2011).

    Google Scholar 

  61. 61.

    Oh, J. Y. et al. Self-seeded growth of poly(3-hexylthiophene) (P3HT) nanofibrils by a cycle of cooling and heating in solutions. Macromolecules 45, 7504–7513 (2012).

    Google Scholar 

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C.Y. would like to acknowledge the support by the National Science Foundation CAREER grant (CMMI-1554499), the Office of Naval Research grant (N00014-18-1-2338) under the Young Investigator Program, the National Institutes of Health grant (R21EB026175) and 3M non-tenured faculty award. F.E. acknowledges the National Science Foundation Graduate Research Fellowship Program.

Author information




C.Y., K.S., F.E., Y.X. and P.Y. conceived and designed the experiments. K.S., Y.Z., H.S., Z.R., Y.L. and A.T. fabricated devices. K.S., F.E., Y.Z., P.Y., H.S. and Z.R. performed the characterization experiments. K.S., F.E., Y.Z., Y.X., P.Y., H.S., Z.R. and A.E. performed the in vivo animal experiments. K.S., F.E., Y.X., H.S. and C.Y. analysed the experimental data. K.S., F.E. and C.Y. wrote the paper. All the authors reviewed and revised the manuscript.

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Correspondence to Cunjiang Yu.

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Sim, K., Ershad, F., Zhang, Y. et al. An epicardial bioelectronic patch made from soft rubbery materials and capable of spatiotemporal mapping of electrophysiological activity. Nat Electron 3, 775–784 (2020).

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