A

Technical Seminar Report On

PACEMAKER

Submitted in partial fulfilment of the requirement for the award of

Bachelor of Technology
In
Electronics and Communication Engineering
BY
ANJALI DHARMINI (20251A0463)

DEPARTMENT OF ELECTRONICS & COMMUNICATION ENGG

G. NARAYANAMMA INSTITUTE OF TECHNOLOGY & SCIENCE
(for women)
(Autonomous)
Accredited by NAAC & NBA
Batch: 2020-2024

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 CONTENTS

S. No Topic Page No
Abstract i
List of Figures ii

List of Abbreviations iii

1 Introduction
1.1 History of pacemaker 6
1.2 Overview 6-7

2 Detailed description
2.1 Temporary pacing 9
2.2 Permanent pacing 9-11
2.3 Pacing lead 11-16
2.4 Complications 16

3 Indications
3.1 Bradycardia 17
3.2 Other indications 17-18

4 Configurations
4.1 single chamber pacemaker 19
4.2 Dual chamber pacemaker 19
4.3 Biventricular pacemaker 19-20
4.4 Implantable pacemaker 20

5 Pulse Generator
5.1 Parts 21
5.2 Working 21

6 Applications and problems 22

7 Conclusions 23

8 References 24

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 ABSTRACT

Certain congenital heart defects , enlarged or thick heart muscle that makes it harder to
pump blood out of your ventricles, heart attack ,heart failure these problems may cause
your blood pumping system to work inefficiently which may arise the need to use a
pacemaker. A pacemaker is an electronic device which carries out a heart’s functionality.
Many advanced and improved versions of pacemakers are invented. This research does the
analysis on the questions related to pace makers like how they are made? technology
used? Why do we need them? When do we need them? What are the improvements? What
are the problems arising by using them? Can we overcome them? Will anything replace
the pacemaker? What are types of pacemakers? Basic pacemaker consists of three parts:
pulse generator, electrode, one or more leads and remote monitoring pacemakers.

Keywords:- remote monitoring, pulse generator, congenital heart defects.

Name:-Anjali Dharmini

Roll No:- 20251A0463

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 LIST OF FIGURES

S. No Fig No. Name of the fig Page No.

1 1.1 Pacemaker 6

2 1.2 Implanted Pacemaker 7

3 2.1 Temporary Pacing 9

4 2.2 Permanent Pacing 10

5 2.3 Bipolar ECG 12

6 2.4 Ventricular demand pacing 13

7 2.5 Synchronous Pacing 13

8 2.6 Atrioventricular sequential pacing 14

9 3.1 Mobitz type 2 AV block 17

10 3.2 Third degree heart block 17

11 3.3 Heart failure 18

12 3.4 HCM 18

13 4.1 Single chamber pacemaker 19

14 4.2 Dual chamber pacemaker 19

15 4.3 Biventricular pacemaker 20

16 4.4 Implantable pacemaker 20

17 5.1 Simple pacemaker 21

18 5.2 Applications 22

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 LIST OF ABBREVIATIONS

S.No. Abbreviation Full Form

1 HCM Hypertrophic cardio myography

2 ECG Electro cardiogram
3 ICD Implantable cardioverter-
Defibrillator

4 DDD Dual Chamber pacing

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 1.INTRODUCTION

1.1 History of pacemaker

The history behind the artificial pacemaker stretches back over 300 years. As a
critical component of numerous scientific developments in medicine, specifically within
cardiology, the pacemaker and its history have provided a foundation for basic
electrophysiology, applied electrotherapy and various treatment technologies devoted to
reducing both the mortality and morbidity of many diseases.

Fig:1.1 Pacemaker

1.2 OVERVIEW:
• A pacemaker is a small device that's placed (implanted) in the chest to help control
the heartbeat. It's used to prevent the heart from beating too slowly. Implanting a
pacemaker in the chest requires a surgical procedure.
• A pacemaker is also called a cardiac pacing device.

• Pacemakers work only when needed.

• Pacemakers consist of 2 parts pulse generator and electrodes.

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 • It's unlikely that your pacemaker would stop working properly because of electrical
interference. Still, you'll need to take a few precautions.
• Cell phones effects the working of pacemakers causing electrical disturbances.

PACEMAKERS:
A pacemaker is a small device used to treat some arrhythmias. During an
arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
Pacemakers send electrical pulses to help your heart beat at a normal rate and
rhythm.

Fig 1.2 Implanted Pacemakers

Pacemakers can also be used to help your heart chambers beat in sync so your heart can pump
blood more efficiently to your body. This may be needed if you have heart failure.

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 2.DETAILED DESCRIPTION

A pacemaker is a battery operated generator that initiates and controls electrical stimulation
of the heart via an electrode that is usually in direct contact with the myocardium.

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2.1. TEMPORARY PACING:
The pulse generator is external and the pacing electrode is inserted by transvenous,
or transcutaneous route either at the beside or under fluoroscopy.
THE TRANSVENOUS ROUTE, which is preferred in emergency situations, requires a
hard tipped or balloon -tipped pacing lead to be guided into the right heart and into contact
with the endocardium.
Temporary transvenous pacing wire in right ventricle inserted through antecubital vein.
Transvenous installation of a permanent pacemaker. For dual -chamber pacing a separate
pacing wire would be in the antrim.

Fig 2.1 Temporary Pacing

PERMANENT PACING

In an operating room, the pulse generator -a small hermetically sealed, lithium

battery weighing from 30-130 gm-is placed into a small tunnel burrowed with the
subcutaneous tissue below the right clavicle (less frequently the left clavicle). The pacing
electrode is inserted via a transvenous route (most common ) or directly applied to the
epicardial surface by thoracotomy.
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 Fig 2.2 Permanent Pacing

The inter society commission for heart disease established a code to create uniform
descriptions of pacemaker function.
First letter: Indicates which chamber is paced :
V: ventricles
A: altruism
D: dual (both atrium and ventricle)
Second letter : Indicates which chamber is sensed
V: ventricles

A: atrium
D: dual(both atrium and ventricle )
O: no sensing
Third letter: Indicates the mode (how the pacemaker responds to intrinsic heart pulses )
I: inhibited response
T: trigger response
D: dual response – inhibited for some sensed impulses and trigger for others
R: reverse- pacer is activated to send out impulses during fast intrinsic heart rates instead
of slow
O: no response to sensed impulses.
Fourth letter: Indicates programmable function
P: programmable

M: multiprogrammable

C: multiprogrammable with telemetry

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 O: none
Fifth letter: Indicates special tachycardia function

B: bursts

N: normal rate competition

S: scanning
E: external

Examples of temporary pulse generators. Single – chamber pulse generator. Dual chamber
pulse generators.
The impulse generator is said to capture the myocardium and there by maintain heart
rhythm.
2.3 PACING LEADS

UNIPOLAR PACEMAKER:
Lead has only one electrode that contacts the heart at its tip pole. The power source
is the pole. Patient serves as the grounding source. Patients body fluids provide the return
pathway for the electrical.
Signal electromagnetic interference occurs more often in unipolar leads.
BIPOLAR LEADS

If bipolar, there are two wires to the heart or one wire with two electrodes at its tip.
Provides a built – in ground lead circuit is completed within the heart provides more contact
with the endocardium ; needs lower
Current to pace less
chance for cautery

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Fig 2.3 Unipolar and Bipolar

BIPOLAR PACING SYSTEM

The atrium is paced and the ventricle is allowed to be depolarization via conduction
of the paced atrial impulse through the normal pathway of the A-V node and the his-
purkinje conduction system. Atrial demand pacing is useful in symptomatic sinus
bradycardia of any kind.

Fig 2.4 Bipolar ECG

VENTRICULAR DEMAND PACING

Patients with episodic A-V block may benefit from ventricular demand pacing. When
spontaneous ventricular depolarizations fall below the preset pacemaker rate,paced ventricular
depolarizations ensure.

Disadvantage is the loss of atrial ventricular synchrony and the atrial kick.

Fig 2.5 Ventricular Demand Pacing 11

 SYNCHRONOUS PACING

Synchronous pacing was the first mode developed to offer dual chamber pacing.
Sensing occurs in both atrium and ventricle. when a p wave is sensed, a ventricular output
pulse is triggered after a preset atrioventricular interval. If a spontaneous QRS complex is
sensed, the paced output is inhibited, thus preventing competitive pacing in the ventricle

Fig 2.6 Synchronous Pacing

ATRIOVENTRICULAR SEQUENCIAL PACING:

In this mode sensing occurs only in the ventricle while pacing occurs sequentially in the
atrium and after a preset AV interval, in the ventricle.
If spontaneous ventricular depolarization follows quickly enough after the paced atrial beat,
inhibition of the ventricular output pulse occurs.

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Fig 2.7 ATRIOVENTRICULAR SEQUENTIAL PACING
UNIVERSAL ATRIOVENTRICULAR PACING

If spontaneous atrial activity does not take place within the preset time limit , atrial
pacing triggered .
Any sensed intrinsic atrial activity inhibits the paced atrial pulse .
If ventricular depolarization in response to a spontaneous or paced atrial beat does
not occur within a present interval, a ventricular stimulus is issued by the pacemaker.
Intrinsic ventricular activity occurring within the pre-set time interval inhibits the
paced ventricular stimulus.
This pacing is indicted in atrial brady arrhythmia with or without abnormal AV
conduction or in normal sinus node function with AV block.
It allows the atrial kick.
It adjust heart rate to meet the metabolic demands of the body.

ECG

Fig 2.8 ECG

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2.1. COMPLICATIONS

1)Thrombophlebitis

2)Arrhythmias

3)pneumothorax

4)Myocardial perforation

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 3.INDICATIONS

3.1. BRADYCARDIA:

Bradycardia (brad-e-KAHR-dee-uh) is a slow heart rate. The hearts of adults at rest

usually beat between 60 and 100 times a minute. If you have bradycardia, your heart beats
fewer than 60 times a minute. Bradycardia can be a serious problem if the heart rate is very
slow and the heart can't pump enough oxygen-rich blood to the body. If this happens, you
may feel dizzy, very tired or weak, and short of breath. Sometimes bradycardia doesn't
cause symptoms or complications.

3.2. OTHER INDICATIONS (TO USE A PACEMAKER ):

• Mobitz type 2 AV block

Fig 3.1 Mobitz type 2 AV block

• Third degree heart block

Fig 3.2 Third degree heart block

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• Heart failure (Biventricular pacemaker)

Fig 3.3 Heart failure

• Hypertrophic obstructive cardio myography (implantable cardioverter

defibrillator):
Hypertrophic cardio myography (HCM) is a disease in which the heart
muscle becomes thickened (hypertrophied). The thickened muscle makes it harder
to heart to pump blood.

Fig 3.4 HCM

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 4.CONFIGURATIONS

There are different configurations based on the number of leads used in the pace
maker

4.1. SINGLE CHAMBER PACEMAKERS:

This type usually carries electrical impulses to the right ventricle of your heart.

Fig 4.1 Single Chamber Pacemaker

4.2. DUAL CHAMBER PACEMAKER:

This type carries electrical impulses to the right ventricle and the right atrium of
your heart to help control the timing of contractions between the two chambers.

Fig 4.2 Dual Chamber Pacemaker 17

4.3 BIVENTRICULAR PACEMAKER:

Biventricular pacing, also called cardiac resynchronization therapy, is for people

who have heart failure and heartbeat problems. This type of pacemaker stimulates both of
the lower heart chambers (the right and left ventricles) to make the heart beat more
efficiently.

Fig 4.3 Biventricular Pacemaker

4.4 IMPLANTABLE PACEMAKERS:

Fig 4.4 Implantable Pacemakers

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 5.PULSE GENERATOR

5.1. PARTS:

● A power source in the form of a battery

● Circuitry (output, sensing, telemetry, microprocessor or microsequencer, memory)

● A metal casing (can) welded shut to keep out fluids

● A feedthrough (a piece of wire surrounded by glass or sapphire) that maintains a hermetic

seal to provide an electrical connection through the can

● A means of connecting a pacing lead (wire to the heart) to the header of the pacemaker
● Sensors (e.g., acceleration, vibration, impedance)

5.2. WORKING:
A cardiac pulse generator is a device having a power source and electronic circuitry
that produce output stimuli. Functionally, at its simplest, current sourced by the device’s

battery travels through a connecting pathway to stimulate the heart and then flows back
into the pacemaker to complete the circuit.

Fig 5.1 Simple Pacemaker

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 6. APPLICATIONS AND PROBLEMS

6.1. APPLICATIONS:

By regulating the heart’s rhythm, a pacemaker can often eliminate the symptoms of
bradycardia. This means individuals often have more energy and less shortness of breath.
However, a pacemaker is not a cure. It will not prevent or stop heart disease, nor will it
prevent heart attacks.

Fig 6.1 Applications

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6.2 PROBLEMS:

• Irregular working of pulse generator

• Bruising

• Bleeding

• Pain around the incision

• Infection

• The pace maker lead moving

• Blood clots (thromboembolism) near the pacemaker site.

• Damage to blood vessels or nerves near the pacemaker.

• Collapsed lung (pneumothorax)

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 7.CONCLUSIONS

Many abnormal heart rhythms can be treated with a pacemaker. A pacemaker

generates electric pulses that regulate heartbeats. Thanks to advances in technology,
pacemakers are very light and can adapt to your body needs, moment by moment, beating
faster during exercise and slowing down at rest.

The procedure to insert a pacemaker is fairly simple and safe. Complications are
rare, but knowing about them may help you to detect them early if they happen. After the
procedure, you can go back to your regular activities after a short period of healing time.
But due to lead disadvantages people even getting ICD.

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 8.REFERENCES

[1] https://www.nhlbi.nih.gov/health/pacemakers/who-needs

[2] https://www.slideshare.net/vijayvandali/pacemaker-89245503?from_action=save

[3] https://youtu.be/53_jyoA47Fk

[4] https://link.springer.com/chapter/10.1007/978-0-387-72763-9_2

[5] https://youtu.be/54taja_HveU

[6] https://youtu.be/WgKCUjPcDY0

[7] https://youtu.be/2w3V4FPqlwU

[8]
https://www.yashodahospitals.com/blog/pacemaker/#:~:text=Conclusion,and%20slowing
%20down%20at%20rest

[9] https://youtu.be/tUtg5p64Y-A

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