Design Cardiac Pacemaker

Project report submitted in partial fulfillment

of the requirements for the degree of

Bachelor of Technology
in

Computer Science and Engineering

by

N. ADITYA CHAND BEHERA

(Roll Number: 119CS0110)

based on research carried out

under the supervision of

Prof. SUMANTA PYNE

October, 2022

Department of Computer Science and Engineering

 National Institute of Technology Rourkela

DepartmentofComputerScienceandEngineering
National Institute of Technology Rourkela

Prof. Sumanta Pyne December 5, 2022

Supervisor’s Certificate

This is to certify that the work presented in the project report entitled Design
Cardiac Pacemaker submitted by N. ADITYA CHAND BEHERA, Roll
Number 119CS0110, is a record of original research carried out by him under
my supervision and guidance in partial fulfillment of the requirements of the
degree of Bachelor of Technology in Computer Science and Engineering.
Neither this project report nor any part of it has been submitted earlier for any
degree or diploma to any institute or university in India or abroad.

Prof. Sumanta Pyne

 Declaration of Originality

I, N. ADITYA CHAND BEHERA, Roll Number 119CS0110 hereby declare

that this project report entitled Design a cardiac pacemaker presents my
original work carried out as a undergraduate student of NIT Rourkela and, to
the best of my knowledge, contains no material previously published or
written by another person, nor any material presented by me for the award of
any degree or diploma of NIT Rourkela or any other institution. Any
contribution made to this research by others, with whom I have worked at NIT
Rourkela or elsewhere, is explicitly acknowledged in the dissertation. Works
of other authors cited in this dissertation have been duly acknowledged under
the sections “Reference” or “Bibliography”.

I am fully aware that in case of any non-compliance detected in future, the

Senate of NIT Rourkela may withdraw the degree awarded to me on the basis of
the present dissertation.

December 31, 2022 N ADITYA CHAND BEHERA

NIT Rourkela
 Abstract
Human heart has four chambers – right atrial, right ventricle, left atrial and left
ventricle. To contract and relax periodically heart requires electric impulses
from sinus node. Sinus node is located in right atrium. Electric signal travels
through conduction pathways to contract and pump out blood. Each contraction
of ventricles represents one heartbeat. Atrials contract for a fraction before the
ventricles contract. Atrial blood empties into ventricles before the ventricles
contract. Malfunction of heart’s electrical system leads to abnormal heart
rhythms – arrhythmia. Heartbeat rate may fall below expected level leading to
bradycardia .Tachycardia occurs when the heartbeat rate goes above expected
level. Artificial pacemaker treats bradycardia by restoring synchrony between
atria and ventricles.
 Contents
Supervisor’s Certificate i
Declaration of Originality ii
Abstract iii
List of Tables v
1 Introduction 1
1.1 Components of a Dual-chamber pacemaker 4
1.2 Dual-chamber Pacemaker in DDDR mode 4
2 Literature Review 6
3 Proposed Method 7
3.1 Implementation
3.2 Battery utilization in cardiac pacemaker
3.3 RESULT
4 Future Scope
References 11
List of Tables

1.1 Time Intervals for a Single Heartbeat Pacing Cycle . . . . . . . . . . . . . . . . . . 5

Chapter 1

Introduction
Pacemaker monitors rate of heart and rhythm If heart does not beat
or beats too slowly, pacemaker provides electrical stimulation.
Pacemakers are classified depending on number of heart chambers
monitored and stimulated. Two types are- Single-chamber and dual-
chamber pacemakers. Dual-chamber pacemaker performs better
than single-chamber pacemaker, in terms of atria fibrillation,
pacemaker syndrome and heart failure. But at the cost of higher
energy consumption. Dual-chamber pacemakers require frequent
battery change. Surgeries are neither easy nor safe as well as
expensive.

Figure . Diagram of a pacemaker system.

Chapter 1 Introduction

1.1 Components of a Dual-chamber

Pacemaker

• A pair of heartbeat sensors and pulse generators for each of

atrial and ventricle.
• A rate modulation sensor to detect body activity
• A pair of countdown timers to keep track of VAI and AVI
• VAI - Ventriculoatrial Interval, AVI - Atrioventricular Interval
• Components are controlled by a program running on a micro-
controller
• Powered by a lithium iodine-polyvinylpyride (PVP) battery

1.2 Dual-chamber Pacemaker in DDDR

mode

• Pacing in both (Dual) chambers

• Sensing in both (Dual) chambers
• Responding by triggering and inhibition (Dual)
• Modulates its activity according to physical activity of patient
(Rate)
Figure. Normal sinus rhythm for a human heart as seen on ECG

Table 1.1: Time Intervals for a Single Heartbeat Pacing Cycle

Chapter 2

Literature Review

• Research published by Mirko Baruscotti titled the cardiac pacemaker

current published in 2010, proposed -In mammals cardiac rate is
determined by the duration of the diastolic depolarization of sinoatrial
node (SAN) cells which is mainly determined by the pacemaker If
current.

• Research published by Mark A. Wood, published in 2002 titled

cardiac pacemaker from patients perspectives proposed - Almost all
pacemakers are implanted to treat slow heart beating, which is called
“bradycardia.” At rest, the heart usually beats about 50 to 70 times each
minute, and the heart rate may increase 2- to 3-fold during stress or
exercise. If the heart beats too slowly, the brain and body do not get
enough blood flow and a variety of symptoms may result.

• Research published by Venkatesvara Mallela published in 2004 titled

trends in cardiac pacemaker batteries A cardiac pacemaker uses half
of its battery power for cardiac stimulation and the other half for
housekeeping tasks such as monitoring and data logging. The first
implanted cardiac pacemaker used nickel-cadmium rechargeable
battery, later on zinc-mercury battery was developed and used which
lasted for over 2 years. Lithium iodine battery invented and used by
Wilson Greatbatch and his team in 1972 made the real impact to
implantable cardiac pacemakers. This battery lasts for about 10 years
 and even today is the power source for many manufacturers of cardiac
pacemakers.

• Research published by Theodore C. West published in 1995 titled

ultramicroelectrode recording from cardiac pacemaker stated The
pacemaker region lies in a flat band of tissue separating the two caval
orifices in the right atrium. In contrast to sites elsewhere in the atria,
recordings from this area exhibit a diastolic prepotential, relatively
slow depolarization and slow repolarization. The magnitude of the
resting membrane potential is less in pacemaker cells and overshoot
during activity characteristically is diminished or absent. By means of
a second microelectrode to establish a time reference, pacemaker cells
showing early firing may be located, although all cells associated with
a prepotential are not necessarily the site of impulse origination.
Chapter 3
Proposed Algorithm
The following program simulates working of a dual chamber cardiac
pacemaker.

1. If atrium sensed is true

i. Set AVI Countdown Timer
ii. If ventricle sensed is true
a) If rate change is true
b) Update AVI
c) Set VAI CountDown Timer
d) Wait PVARP
e) Repeat step 1

Else
i. If AVI expired is true
a) Pace Ventricle
b) Repeat step 1.ii
Else
Repeat step 1.ii

Else
i. If VAI expired is true
a. Pace Atrium
b. Repeat step 1
Else
Repeat step 1
Chapter 3 Proposed Algorithm

3.1 IMPLEMENTATION

• FIRST.c

#include "pacemaker.h"
int main(int argc, char *argv[])
{
FILE *fp = fopen("cardiac_signal_trace.txt", "r");
unsigned int c=0,pace_atrium_counter=0,pace_ventricle_counter=0;
while (c<max_cycles)
{
wait_PVARP();
switch(sense_atrium(fp))//sense atrium
{
case 0: pace_atrium(); // pacing atrium if atrium not sensed
pace_atrium_counter++;
break;
case 1: // no pacing atrium if atrium sensed
break;
case 2: printf("EOF reached.\n");// Stop if EOF reached
c=max_cycles;
}
switch(sense_ventricle(fp))//sense ventricle
{
case 0: pace_ventricle(); // pacing ventricle if ventricle not sensed
pace_ventricle_counter++;
break;
case 1: // no pacing ventricle if ventricle sensed
break;
 case 2: printf("EOF reached.\n");// Stop if EOF reached
c=max_cycles;
}
if(is_change_rate())//check rate change

update_VAI();
c++;
}
fclose(fp);

return 0;
}

• SECOND.c

#include<stdio.h>
#include<stdlib.h>
#include"pacemaker.h"

int main()
{
FILE*fp=fopen("cardiac_signal_trace.txt","w");

unsigned int
c,v,p,pvarp_counter,pflag,qflag,atrial_signal,ventricle_signal,a,pace_atriu
m_counter=0,pace_ventricle_counter=0;
for(c=0;c<max_cycles;c++)
{

for(pvarp_counter=0;pvarp_counter<PVARP_length;pvarp_counter++
)
fputc('-',fp);
 for(v=PVARP_length;v<=(VAI_length-p_wavelength);v++)
fputc('-',fp);
pflag=0;
for(p=0;p<p_wavelength;p++)
{
atrial_signal=rand()%100;
if((!atrial_signal)&&(!pflag))
{
fputc('P',fp);
pflag=1;
}
else
fputc('-',fp);
}
if(!pflag)
{
// printf("Pace atrium");
pace_atrium_counter++;
}
qflag=0;
for(a=0;a<AVI_length;a++)
{
ventricle_signal=rand()%100;
if((!ventricle_signal)&&(!qflag))
{
fputc('Q',fp);
qflag=1;
}
else
fputc('-',fp);
}
if(!qflag)
{
// printf("Pace ventrium");
pace_ventricle_counter++;
 }
}
printf("#pace_atrium=%u
#pace_ventrium=%u",pace_atrium_counter,pace_ventricle_counter);
fclose(fp);
return 0;
}

3.2 Battery utilization in cardiac

pacemaker

Each of the following activities results in battery utilization. Thus

leading to depletion of battery power by certain amount.
Our goal is to calculate the battery power after each of the following
activities.

Consider, 1Coulomb = 10.0E+12 charge units

Battery capacity = 7.56E+15 charge units

Operational Current (mA) Duration (msec)

Sense atrial 22.3 850

Pace atrial 64.0 1
Sense ventrical 82.5 150
Pace ventrical 112.8 1
VAI Timer 122.7 850
AVI Timer 96.4 150
Change and update rate 34.7 1

Following the relation Q=I*t

3.3 RESULT
3.3 FUTURE SCOPE

Design a stochastic B-SC model.

• Unpredictable workloads - discharge SC or keep it
recharged for future
• Single SC replaced by multiple SCs with equivalent
capacitance
• Multiple SCs beneficial where some SCs discharged,
others recharged
• Need to design a suitable model for B-SC
• Find required capacity of SC for an embedded system
with battery B
• Find number of SCs to meet successive and
simultaneous workloads

References

[1] Journal of Pharmacology and Experimental Therapeutics November 1955, 115 (3)
283-290;

[2] Yesil M, Bayata S, Postaci N, Aydin C. Pacemaker inhibition and asystole in a

pacemaker dependent patient.
[3] Indian Pacing Electrophysiol J. 2004 Oct-Dec; 4(4): 201–212.
Published online 2004 Oct 1

[4] Haeberlin, A. et al. The first batteryless, solar-powered cardiac pacemaker. Heart
Rhythm 12, 1317–1323

[5] Demosthenous, A. Advances in microelectronics for implantable medical devices.

Adv. Electron. https://doi.org/10.1155/2014/981295 (2014).

References