Self-powered implantable medical electronic devices that harvest biomechanical energy from cardiac motion, respiratory movement and blood flow are part of a paradigm shift that is on the horizon. Here, we demonstrate a fully implanted symbiotic pacemaker based on an implantable triboelectric nanogenerator, which achieves energy harvesting and storage as well as cardiac pacing on a large-animal scale. The symbiotic pacemaker successfully corrects sinus arrhythmia and prevents deterioration. The open circuit voltage of an implantable triboelectric nanogenerator reaches up to 65.2 V. The energy harvested from each cardiac motion cycle is 0.495 μJ, which is higher than the required endocardial pacing threshold energy (0.377 μJ). Implantable triboelectric nanogenerators for implantable medical devices offer advantages of excellent output performance, high power density, and good durability, and are expected to find application in fields of treatment and diagnosis as in vivo symbiotic bioelectronics.

Mechanical energy in vivo could be harvested by BD-TENG in a designed time frame.

Implantable medical devices provide an effective therapeutic approach for neurological and cardiovascular diseases. With the development of transient electronics, a new power source with biocompatibility, controllability, and bioabsorbability becomes an urgent demand for medical sciences. Here, various fully bioabsorbable natural-materials-based triboelectric nanogenerators (BN-TENGs), in vivo, are developed. The "triboelectric series" of five natural materials is first ranked, it provides a basic knowledge for materials selection and device design of the TENGs and other energy harvesters. Various triboelectric outputs of these natural materials are achieved by a single material and their pairwise combinations. The maximum voltage, current, and power density reach up to 55 V, 0.6 µA, and 21.6 mW m , respectively. The modification of silk fibroin encapsulation film makes the operation time of the BN-TENG tunable from days to weeks. After completing its function, the BN-TENG can be fully degraded and resorbed in Sprague-Dawley rats, which avoids a second operation and other side effects. Using the proposed BN-TENG as a voltage source, the beating rates of dysfunctional cardiomyocyte clusters are accelerated and the consistency of cell contraction is improved. This provides a new and valid solution to treat some heart diseases such as bradycardia and arrhythmia.

Soft wearable electronics for underwater applications are of interest, but depend on the development of a waterproof, long-term sustainable power source. In this work, we report a bionic stretchable nanogenerator for underwater energy harvesting that mimics the structure of ion channels on the cytomembrane of electrocyte in an electric eel. Combining the effects of triboelectrification caused by flowing liquid and principles of electrostatic induction, the bionic stretchable nanogenerator can harvest mechanical energy from human motion underwater and output an open-circuit voltage over 10 V. Underwater applications of a bionic stretchable nanogenerator have also been demonstrated, such as human body multi-position motion monitoring and an undersea rescue system. The advantages of excellent flexibility, stretchability, outstanding tensile fatigue resistance (over 50,000 times) and underwater performance make the bionic stretchable nanogenerator a promising sustainable power source for the soft wearable electronics used underwater.

Harvesting biomechanical energy in vivo is an important route in obtaining sustainable electric energy for powering implantable medical devices. Here, we demonstrate an innovative implantable triboelectric nanogenerator (iTENG) for in vivo biomechanical energy harvesting. Driven by the heartbeat of adult swine, the output voltage and the corresponding current were improved by factors of 3.5 and 25, respectively, compared with the reported in vivo output performance of biomechanical energy conversion devices. In addition, the in vivo evaluation of the iTENG was demonstrated for over 72 h of implantation, during which the iTENG generated electricity continuously in the active animal. Due to its excellent in vivo performance, a self-powered wireless transmission system was fabricated for real-time wireless cardiac monitoring. Given its outstanding in vivo output and stability, iTENG can be applied not only to power implantable medical devices but also possibly to fabricate a self-powered, wireless healthcare monitoring system.

Cardiovascular diseases are the leading cause of death globally; fortunately, 90% of cardiovascular diseases are preventable by long-term monitoring of physiological signals. Stable, ultralow power consumption, and high-sensitivity sensors are significant for miniaturized wearable physiological signal monitoring systems. Here, this study proposes a flexible self-powered ultrasensitive pulse sensor (SUPS) based on triboelectric active sensor with excellent output performance (1.52 V), high peak signal-noise ratio (45 dB), long-term performance (10 cycles), and low cost price. Attributed to the crucial features of acquiring easy-processed pulse waveform, which is consistent with second derivative of signal from conventional pulse sensor, SUPS can be integrated with a bluetooth chip to provide accurate, wireless, and real-time monitoring of pulse signals of cardiovascular system on a smart phone/PC. Antidiastole of coronary heart disease, atrial septal defect, and atrial fibrillation are made, and the arrhythmia (atrial fibrillation) is indicative diagnosed from health, by characteristic exponent analysis of pulse signals accessed from volunteer patients. This SUPS is expected to be applied in self-powered, wearable intelligent mobile diagnosis of cardiovascular disease in the future.

Operation time of implantable electronic devices is largely constrained by the lifetime of batteries, which have to be replaced periodically by surgical procedures once exhausted, causing physical and mental suffering to patients and increasing healthcare costs. Besides the efficient scavenging of the mechanical energy of internal organs, this study proposes a self-powered, flexible, and one-stop implantable triboelectric active sensor (iTEAS) that can provide continuous monitoring of multiple physiological and pathological signs. As demonstrated in human-scale animals, the device can monitor heart rates, reaching an accuracy of ∼99%. Cardiac arrhythmias such as atrial fibrillation and ventricular premature contraction can be detected in real-time. Furthermore, a novel method of monitoring respiratory rates and phases is established by analyzing variations of the output peaks of the iTEAS. Blood pressure can be independently estimated and the velocity of blood flow calculated with the aid of a separate arterial pressure catheter. With the core-shell packaging strategy, monitoring functionality remains excellent during 72 h after closure of the chest. The in vivo biocompatibility of the device is examined after 2 weeks of implantation, proving suitability for practical use. As a multifunctional biomedical monitor that is exempt from needing an external power supply, the proposed iTEAS holds great potential in the future of the healthcare industry.

Changes in endocardial pressure (EP) have important clinical significance for heart failure patients with impaired cardiac function. As a vital parameter for evaluating cardiac function, EP is commonly monitored by invasive and expensive cardiac catheterization, which is not feasible for long-term and continuous data collection. In this work, a miniaturized, flexible, and selfpowered endocardial pressure sensor (SEPS) based on triboelectric nanogenerator (TENG), which is integrated with a surgical catheter for minimally invasive implantation, is reported. In a porcine model, SEPS is implanted into the left ventricle and the left atrium. The SEPS has a good response both in low-and high-pressure environments. The SEPS achieves the ultrasensitivity, real-time monitoring, and mechanical stability in vivo. An excellent linearity (R 2 = 0.997) with a sensitivity of 1.195 mV mmHg −1 is obtained. Furthermore, cardiac arrhythmias such as ventricular fibrillation and ventricular premature contraction can also be detected by SEPS. The device may promote the development of miniature implantable medical sensors for monitoring and diagnosis of cardiovascular diseases.