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An MD&DI September 1997 Column

SNAPSHOT

Suresh Gurunathan attempts to control fibrillation.

It's one thing to do research that has the potential to save lives. It's quite another to do it in graduate school. While working toward a graduate degree in biomedical engineering at Virginia Commonwealth University (VCU; Richmond, VA), Suresh Gurunathan sought to reduce the amount of voltage required to stabilize a heart experiencing ventricular fibrillation. His research involved placing three orthogonal ECG leads on the heart of a canine subject, inducing fibrillation, and writing the software to analyze the distressed heart's waveforms. He wanted to find the critical point at which a shock is most likely to defibrillate the heart.

Such innovative research, outlined in his paper, "Vector Magnitude Using Orthogonal ECG Leads during Ventricular Fibrillation Is Associated with Defibrillation Outcome," was recognized by the Association for the Advancement of Medical Instrumentation (AAMI), which honored Gurunathan with a Becton Dickinson Career Achievement Award in June. The award is given to promising health-care professionals under the age of 40 who have made significant contributions to medical devices, instruments, or systems.

"The award came as a big surprise," says Gurunathan. "I had originally sent in my thesis for consideration for the Young Investigator Award given at the AAMI conference, but instead I received this one."

Interested in both electronics and biology in India, Gurunathan received BS degrees in electronics engineering and biological sciences from the Birla Institute of Technology and Science in Pilani in just five years. He then came to the United States to finish his graduate work and gain professional experience. It was at VCU that he became involved in heart fibrillation research. "My advisor, Dr. Peng-Wie Hsia, was already researching fibrillation and encouraged me to do the same," says Gurunathan. "I designed the three-lead system and wrote the software that analyzes the heart's waveforms."

Gurunathan found that there is a critical moment during ventricular fibrillation when the heart is susceptible to defibrillation. Applying a low level of shock at this critical point, rather than a higher one (current defibrillators apply about 15 J or more) at any time during fibrillation, can stabilize the heart. "Reducing the voltage required to defibrillate a heart can reduce heart tissue damage," he says. "The system also finds the critical point for defibrillation. Current practitioners often have to repeat the process, which usually involves increasing the voltage, if the heart doesn't stabilize the first time."

Reducing the amount of energy needed for defibrillation should also help implantable cardiac defibrillator (ICD) makers reduce the size of the batteries and capacitors used in the devices, thereby reducing the size of the ICDs themselves.

Despite the accomplishments Gurunathan and his fellow researchers have made, he is careful to point out that his research is still only a scientific study. "The system we have been using isn't ready to be integrated into devices yet," he says. "The next objective is to find the exact position on the heart so we can use only one lead." His research involved placing the three leads on the x-, y-, and z-axes of the heart of a canine subject.

However, the medical community doesn't have to wait for the technology to be transferred to a device in order for the research to become beneficial. An important aspect of his research, says Gurunathan, was the information it generated about the mechanisms of fibrillation and defibrillation. "Until now the mechanisms were unknown," he explains. "My research involving real-time analysis could help explain them."

Gurunathan's research has also helped him personally--it landed him a job. Ventritex, Inc. (Sunnyvale, CA), a manufacturer of automatic ICDs, funded part of Gurunathan's research at VCU. In March he joined the company as a software engineer and is currently working on the company's next generation of ICDs.

For now Gurunathan plans to stay in the United States to gain more experience. "Biomedical software engineers in India don't work on as advanced projects as they do here," he says. But returning home to work is always something he entertains. "Maybe I'll start my own business in India, but I'll keep in touch with U.S. contacts."

Gurunathan's return home to work might do his fellow citizens a favor. If he were to bring his knowledge of ICD technology to India, he might be able to work toward making the devices available to the general public. "Right now, ICDs are only affordable for the rich," he laments. "As far as I know, no pacemakers or ICDs are made over there. If such manufacturers were there, the devices would be more affordable for the citizens of India."

Even if he remains in the United States to start a business, he plans to keep his countrymen in mind. "I could stay here and export to India," he muses. "But eventually, I want to settle there. It is my home."

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