Ch7_BME460_Defibrillator

Biomedical Instruments-BME460
Chapter 7: Cardiac Defibrillators

R. S. Khandpur, 2nd Edition, Chapter 26
Dr. Qasem Qananwah
12/11/2022 Biomedical Instrument-BME 460 Biomedical Systems and Informatics Engineering Department 1
CHAPTER 7: Cardiac Defibrillator
CHAPTER OUTLINE
• Need for Defibrillator –arrhythmias
• Defibrillation Process
• Defibrillation strength and Duration
• Types of Defibrillators
External
Internal - Endocardial
Internal - Epicardial
• Defibrillation Electrodes
• Implantable Defibrillators
Introduction
(a)
(b)
Figure : Pacemaker (a) Implantable Defibrillators, (b) External Defibrillator
Need for Defibrillation
heart muscle fibres are

continuously stimulated by
adjacent cells
Source: http://www.bem.fi/book/19/19.htm
Figure : Restoration of normal rhythm in fibrillating heart as achieved by direct current shock (arrow) across the chest wall.
http://nursingcrib.com/critical-care-and- http://www.miamiaeds.com/
emergency-nursing/code-blue-defibrillation/
• Used to treat ventricular fibrillation (cardiac arrest) loss of coordinated
contraction of muscle fibers in ventricles, death occurs in minutes if left
untreated.
• 500,000 cardiac arrest cases occur annually in US.

• 1,844 out of 12,223 death due to Ischemic heart disease in Jordan
(statistics 2004)
• Defibrillation involves the application of a strong electrical shock designed
to depolarize most of the heart cells simultaneously, which often
reestablishes coordinated contractions and a normal sinus rhythm.
• Exact physical mechanism leading to ventricular fibrillation is not known.
Defibrillation Curve
Defibrillation Strength Duration Curve

• pulse amplitude in tens of amperes (few thousand volts).
• operator selects energy delivered: 50-400 joules, depends
on:
1. intrinsic characteristics of patient
2. patient’s disease
3. duration of arrhythmia
4. patient’s age
5. type of arrhythmia (more energy required for v. fib.)
Defibrillation Process
Monophasic and biphasic waveform
External Defibrillators
• For each minute elapsing between onset of ventricular fibrillation

and first defibrillation, survival decreases by 10%.
• Defibrillators should be portable, battery operated, small size.
• Energy in defibrillators usually stored in large capacitors.
• Total energy stored in capacitor:
1
WC  CVC2
2
Vc = capacitor voltage
Fig. 26.2: Schematic diagram of a defibrillator
Capacitive Discharge Defibrillator
L Rlead
power
supply + Rchest
Vc C
_
Vchest C: (10 – 50)μF, takes about 10s to full charge

2kV Vc: (4,000 - 9,000) V for a maximal Energy of 400J
up to 40% of energy in C can be dissipated in L and Ri
response is slightly underdamped (depends on chest resistance R)
~10 ms t
Example: Rlead
power +
supply +
Vchest Rchest
Vc C
_
_
Rchest = 95Ω, Rlead = 5Ω, total energy stored in C is W = 300 J, want

to deliver 90% of W to heart in 8 ms. What value of C should be used?
RL  Rlead  Rchest
VC t   VC 0e  t / RL C , t  0
VC(0) = initial capacitor voltage after charging
Example (Cont.):
Rchest
Vchest t   VC t 
Rchest  Rlead
Rchest
 VC 0e  t / RL C
 VC 0e  t / RL C  ……..(1)
Rchest  Rlead
Energy stored in capacitor at t = 0:
0 0

W   VC iC dt   VC  C
dVC 
 dt
 dt 
 
0
1
 C  VC dVC  CVC 0 2
….…..(2)

2
Example (Cont.):
energy delivered to Rchest:
Wchest  t   
tV2
chest  t  dt
0 Rchest
substituting (1):
Wchest t     2
tV2
C  
0 e  2t / R LC
dt
0 Rchest
using (2): 1 0.008 V 2  0e  2 t / R L C

0.9  CVC2 0   2  C
dt
2 0 Rchest
Example (Cont.):
 2 ( 0.008) / R L C
 0.9 /   e 1
 2 ( 0.008) / R L C
0.0526  e
solving for C give: C = 54.3 μF
initial voltage across capacitor:

1
300J  CVC 0
2
2
Vc(0)=3,322.90V
Square Wave Defibrillators

Rlead
SCR2
power +
+ Load voltage regulated by
supply SCR1 thyristor (Silicon controlled
Vc Vchest Rchest
rectifier SCR).
C timing
_
circuit _
• during charging, SCR1 and SCR2 both open

• to defibrillate, SCR2 closes, current flows to chest Vchest
• after a fixed interval, SCR1 closes, shorts out C
(a) Basic circuit diagram for a capacitive–discharge type of cardiac defibrillator. (b) A
typical waveform of the discharge pulse. The actual waveshape is strongly
dependent on the values of L, C, and the torso resistance RL.
• Defibrillation process assessment:
• HR
• PR, RR interval stability
• more sophisticated electrogram analysis.
Example:
A defibrillator provides a 5 ms pulse of 20 A to a

50  load.
Thus the energy delivered is
E = P = I2Rt =
(20A)2(50)(0.005s) = 100
J.
Automatic External Defibrillators (AEDs)
• Two modes of operation:

• Automatic: AED recognizes specific arrhythmias via
signal processing algorithms, applies shock as needed.
No manual control.
• Semi-automatic: operator must confirm shock advisory
from AED to deliver the shock.
• Less operator training needed
Automatic External Defibrillators (AEDs)
LIFEPAK 500 Automatic

External Defibrillator
(AED) weighs 3 kg and is
portable (Medtronic inc.
2001).
Defibrillator Electrodes
• Usually from metal, 70-100 cm2 surface area
• must be coupled to skin using conductive material (otherwise can
burn patient)
Two types of electrodes:
• Hand-held: conductive gel must be manually applied, reusable.
• Adhesive : adhesive conducting material holds electrode to
skin, disposable
Hand-Held Defibrillators Electrodes
Electrodes used in cardiac defibrillation are in two shapes
(a) A spoon-shaped internal electrode that is applied directly to the
heart.
(b) A paddle-type electrode that is applied against the anterior chest
wall.
Hand-Held Defibrillators Electrodes
Hand-held transthoracic electrode (From Tacker Jr. 1980).
Button
Adhesive Type Defibrillators Electrodes
Some examples of the pre-applied adhesive electrodes (From

Tyco/Healthcare Kendall  LTP 2001)
Defibrillators Electrodes
Electrode Placement
anterior wall placement front-to-back placement
CARDIOVERSION
• Cardioversion is also a shock supplied to treat other types of

arrhythmias such as:
• Atrial fibrillation
• Ventricular tachycardia (rapid heart rate)
• These types of arrhythmias are not life threatening but do

result in reduced cardiac output
• It is important that the cardioversion pulse not coincide with a

T-wave otherwise ventricular fibrillation may result.
CARDIOVERSION
standby
power charge discharge

gate patient
supply
switch is under
operator control
energy timing ECG

storage circuitry monitor
applies shock about 20-30 ms

after QRS complex
Block diagram of Cardioversion
CARDIOVERSION
DC Synchronized Defibrillators
In cardioverter, the
defibrillation pulse in
this case must be
synchronized with the R
wave of the ECG so that
it is applied to a patient
shortly after the
occurrence of the R
wave.
Implantable Defibrillators
• Introduced for the first time by

Cardiac Pacemaker Inc (1985) in
USA
• Recommended for patients of high
risk for VF
• Usually combined with pacemaker
Implantable cardioverter defibrillator (ICD) (Medtronic inc., 2001).
• Treat v. fibrillation, tachycardia

• Usually incorporated as part of an implanted cardiac pacemaker
(typically VVI). Normally Biphasic wave is used
• Specifications:
• ~ 750V
• 30-35J
• Heart load ~ 50Ω
• Shock duration 4-8ms
Safety during defibrillation process:
• Operator should be careful not to touch

electrodes during defibrillation.
• Other personnel should remain clear of patient
and any metal objects contacting patient
during defibrillation.
The End…
Questions?????

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Biomedical Instruments-BME460

Chapter 7: Cardiac Defibrillators

Figure : Pacemaker (a) Implantable Defibrillators, (b) External Defibrillator

heart muscle fibres are

• 500,000 cardiac arrest cases occur annually in US.

• Exact physical mechanism leading to ventricular fibrillation is not known.

Defibrillation Strength Duration Curve

Monophasic and biphasic waveform

• For each minute elapsing between onset of ventricular fibrillation

Fig. 26.2: Schematic diagram of a defibrillator

Vchest C: (10 – 50)μF, takes about 10s to full charge

Rchest = 95Ω, Rlead = 5Ω, total energy stored in C is W = 300 J, want

using (2): 1 0.008 V 2  0e  2 t / R L C

initial voltage across capacitor:

Square Wave Defibrillators

• during charging, SCR1 and SCR2 both open

A defibrillator provides a 5 ms pulse of 20 A to a

Automatic External Defibrillators (AEDs)

• Two modes of operation:

Automatic External Defibrillators (AEDs)

LIFEPAK 500 Automatic

Hand-held transthoracic electrode (From Tacker Jr. 1980).

Adhesive Type Defibrillators Electrodes

Some examples of the pre-applied adhesive electrodes (From

anterior wall placement front-to-back placement

• Cardioversion is also a shock supplied to treat other types of

• These types of arrhythmias are not life threatening but do

• It is important that the cardioversion pulse not coincide with a

power charge discharge

energy timing ECG

applies shock about 20-30 ms

• Introduced for the first time by

Implantable cardioverter defibrillator (ICD) (Medtronic inc., 2001).

• Treat v. fibrillation, tachycardia

Safety during defibrillation process:

• Operator should be careful not to touch

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