Magnetic fluid injected into the heart could stop strokes before they start

ClareM/Shutterstock.com Millions of people have a heart rhythm disorder called atrial fibrillation, which causes the heart’s upper chambers or atria to beat chaotically rather than in a smooth, coordinated rhythm. For many, the symptoms can be mild with palpitations, fatigue or breathlessness, but the greatest danger is something far more serious – a stroke. Tucked inside the heart is a tiny pouch called the left atrial appendage. When the heart beats erratically, blood can pool and sit still in this pouch instead of flowing normally – and still blood tends to clot. If one of those clots breaks free and travels to the brain, it can block bloodflow and cause a stroke. Atrial fibrillation makes you about five times more likely to have a stroke. The question for researchers, then, has been whether that pouch could simply be taken out of the equation. Researchers recently revealed one possible answer – a new technique, so far tested only in animals, in which a magnetically guided liquid is injected into the heart, hardening to permanently seal the pouch from the inside. Early tests in rats and pigs suggest that this method could one day lower the risk of stroke in people with atrial fibrillation. Current treatments are effective but imperfect. Today, most patients are prescribed blood-thinning drugs, such as anticoagulants. These drugs reduce the ability of blood to clot and significantly lower the risk of having a stroke. However, anticoagulants come with trade-offs. They increase bleeding risk, which can be dangerous for some patients – particularly older adults or those with other medical conditions such as stomach ulcers, hypertension, liver or kidney disease and cancer. Some people cannot tolerate them or must stop treatment because of bleeding complications. Another option is a procedure called left atrial appendage occlusion, in which doctors implant a small device to plug the appendage. The most widely known devices are delivered using a catheter and expand like a small metal umbrella to seal the opening. Atrial fibrillation makes you five times more likely to have a stroke. PeopleImages/Shutterstock.com

These devices can be effective, but they are not perfect. Because the appendage varies widely in shape and size between patients, rigid implants may not always create a complete seal. Sometimes a little blood can leak around the edges, and small clots can form on the surface of the device. The parts that hold the device in place can also damage the heart tissue. The newly reported approach takes a radically different path. Instead of inserting a rigid implant, researchers inject a magnetically responsive liquid, sometimes called a magnetofluid, directly into the left atrial appendage through a catheter. Once inside the cavity, an external magnetic field helps guide and hold the fluid in place, so it fills the entire appendage, even against the force of circulating blood. Within minutes, the liquid reacts with water in the blood and transforms into a soft “magnetogel” that seals off the cavity. Because the material begins as a liquid, it can adapt precisely to the highly irregular shape of each patient’s left atrial appendage. In theory, this allows it to create a more complete seal than conventional rigid devices. The gel also appears capable of integrating with the heart’s inner lining, forming a smooth surface that may reduce the chance of a clot forming. Encouraging early results So far, the technique has only been tested in animals. Researchers first evaluated the concept in rats and then progressed to experiments in pigs, an important milestone in cardiovascular research. In the pig study, the magnetogel remained stable inside the appendage for 10 months with no evidence of a clot or leakage. The heart’s inner lining grew over the surface of the gel, creating a continuous, apparently healthy layer. When compared with conventional metal occlusion devices in pigs, the magnetogel produced a smoother lining and avoided the tissue damage associated with anchoring barbs. Equally important, the researchers did not observe harmful biological effects in the animals. Pigs are widely used in cardiovascular research because their hearts closely resemble human hearts, being similar in size, structure and function. Showing that the magnetofluid works safely in a pig heart therefore provides a valuable proof-of-concept. But it does not yet guarantee that the technology will be safe or effective in people. Of all mammals, pigs’ hearts most closely resemble human’s hearts. Angela Buser/Shutterstock.com

Despite the promising results, the technique remains firmly in the experimental stage. Before human trials can begin, researchers must demonstrate long-term safety, refine how the material is delivered and ensure it behaves predictably in larger animal studies. There are also some practical problems to fix. For example, the magnetic material can affect MRI heart scans, making parts of the heart harder to see. Problems like this need to be solved before it can be used in patients. Also, medical devices have to go through a lot of testing, so it will probably take many years before it can be used in real treatments. If the technology ultimately proves safe and effective in humans, it could offer a new way to protect people with atrial fibrillation from stroke. A catheter-delivered liquid seal might provide an alternative for patients who cannot tolerate anticoagulant drugs and could overcome some of the limitations of existing occlusion devices. Given that atrial fibrillation affects tens of millions of people worldwide, even modest improvements in stroke prevention could have a substantial impact on global health. For now, the magnetic gel remains a laboratory innovation rather than a clinical therapy. But it highlights how advances in materials science and biomedical engineering are opening new possibilities for tackling one of cardiology’s most persistent challenges.

David C. Gaze does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.