BIOMEDICAL INSTRUMENTATION

PACEMAKERS
Presenters:
Pradeep Parthasarathy M (160151601052)
Shahariyar KM (160151601085)
Biotech B
Introduction

Pacemaker is an electrical pulse generator for starting and/or

maintaining the normal heart beat. The output of the pacemaker
is applied either externally to the chest or internally to the heart
muscle.

The basic parts of

Pacemaker
 When do we need a Pacemaker?

BRACHYCARDIA - a condition in which heart beats slowly less than 60 beats

per minute

TACHYCARDIA - A condition in which heart beats too fast than 60 beats per
minute

ATRIAL FIBRILLATION - The upper chambers of heart beat rapidly

HEART FAILURE - a condition in which heart beat is not sufficient to supply

enough amount of blood volume.
Pacemaker components

● Pulse generator : Power

source or battery
● Leads or wires
● Cathode ( negative
electrode)
● Anode ( positive electrode)
● Body tissue
 Pacemaker - Design

•They are packaged in hermetically (airtight) sealed metal packages.

•Titanium
•Stainless steel

•Special electron beam or laser welding techniques are used to seal these packages
without damaging the electronic circuit or the power source.

•Metal packages takes less volume and are more reliable than polymer-based
packages.
 Power supply

Battery made up of primary cells were used in 1970s. Required replacement in every
two years.

Currently Lithium Iodide batteries are used

•Increased life time
•Open circuit voltage of 2.8 V.
•Highly reliable
•Relatively High source resistance is a major limitation.
Timing Circuit

•Implemented by free running oscillators

•Advanced pacemakers have timing circuits to determine when a

stimulus should be applied to the heart.

•Complex logic circuits, quartz crystal control & Microprocessor

based circuits are in use today.
Output circuit/Pulse generator

•Produces the actual electrical stimulus that is applied to the heart.

•Generates an electrical stimulus pulse that has been optimized for

stimulating the myocardium through the electrode system that is
being applied with the generator.

•Constant-voltage or constant-current amplitude pulses are the two

usual types of stimuli produced by the output circuit.
Output Circuit

•Constant-voltage amplitude pulses are typically in the range of 5.0

to 5.5 V with a duration of 500 to 600 µs.

•Constant-current amplitude pulses are typically in the range of 8

to 10 mA with a pulse duration ranging from 1.0 to 2.0 ms.

•Pulse rates ranges from 70 to 90 beats per minute.

 Lead wires and electrodes

Requirements:
•Must be mechanically strong

•Must be able to withstand constant motion of the beating heart.

•Must maintain good electrical insulation to prevent the possibility of

shunting important stimulating current away from its intended point of
application on the heart.
 Lead wires and electrodes

•Consists of interwound helical coils of spring-wire alloy molded in a silicone-

rubber or polyurethane cylinder.

•The helical coiling of wire minimizes the stress applied to it.

•Multiple strands serve as insurance against failure of the pacemaker

following rupture of a single wire.

•The soft compliant silicone rubber encapsulation both maintains flexibility of

the lead-wire assembly and provides electrical insulation and biological
compatibility.
 Methods of simulation
External Stimulation
○ Restart normal rhythm of the heart in case
of cardiac stand still
○ Stand still can occur during heart surgery,
sudden physical shock or accident.
○ Paddle shaped electrodes are applied to
surface of the chest and currents in range
of 20 - 150 mA are employed
Internal Stimulation
○ Cases requiring long term pacing in case of
permanent damage
○ Elecctrodes in form of fine wire of teflon
coated with stainless steel.
○ During restarting of heart after open heart
surgery spoon like electrodes are used.
○ Currents in range of 2 - 15mA are used.
 Unipolar Pacing system

● A lead with only one electrode

within the heart
● The impulse flows through the
tip electrode(cathode)
● Stimulates the heart
● Returns through body fluid and
tissue to the IPG (anode)
 Bipolar Pacing system

● Contains lead with two

electrodes in the heart
● Impulse flows through the tip
electrode at the end of lead wire
● Stimulates the heart
● Returns to the ring electrode
above the lead tip.
Temporary(External) pacemaker
● Are intended for short-term use during hospitalization. Are used to support
patients until they improve or reserve a Permanent pacemakers or long
enough to start a normal heart rhythm
● Epicardial wires and the endocardial may be Temporary.
● The electrodes are called endocardiac electrodes and are applied to the heart
by means of an electrode catheter with electrode’s tip situated in the apex of
the right ventricle. These are in contact with the inner surface of the heart
chamber
● Located outside the body, and may be taped to the skin or attached to a belt
or to the patient's bed.
● No open heart surgery
● No swelling or pain due to minimum foreign body reaction.
● Easy replacement of battery or defect can be easily attended.
Permanent(Internal) pacemakers
● Permanent pacemakers are pacemakers that are intended for long- term use
● Surgically implants beneath the chest or abdomen with output leads directly
connected to the heart muscle.
● The electrodes are called myocardiac electrodes and are in contact with the
outer wall of the myocardium ( heart muscle). Endocardiac electrodes are also
used.
● The generator implanted in a subcutaneous pocket.
● They last approximately 6 to 12 years.
● Requires an open chest minor surgery
● Battery can only be replaced after a minor surgery.
● Swelling and pain might occur due to foreign body reaction.
● Complete safety for pacemaker from external disturbances
Different modes of operation

● Several pacidng modes are possible with bot internal and

external pacemakers
● Competitive ( Asyncrhonous) or Non competitive ( syncrhonous)
● Asyncrhonous pacing - fixed rate impulses may occur along with
natural pacing impulses and could therefore in competition with
them in controlling the heart beat.
● Syncrhonous - generally programmed either in demand or
synchronised mode.
Five types of Pacemakers

● Ventricular asynchronous Pacemkaer ( fixed rate pacemaker)

● Ventricular synchronous Pacemaker
● Ventricular inhibited pacemaker ( demand pacemaker)
● Atrial syncrhonous pacemaker
● Atrial sequential ventricular inhibited pacemaker
Ventricular asynchronous Pacemaker

● First type of pacemaker and can be used in atrium or ventricle

● Simple mechanism and longest battery life
● Patients with stable, total AV block, a slow atrial rate or atrial
arrhythymia
● Simple astable multivibrator
● Produces stimulus at a fixed rate irrespective of behaviour of
heart rhythym.
● Danger of Ventricular fibrillation might occur.
Ventricular Synchronous Pacemaker (standby)

● Patients with only short periods of AV block or bundle block

● Do not compete with normal heart activity
● Single transverse electrode placed in the right ventricle both
senses R wave and delivers the stimulation - no separate
sensing electrode is required.
● R - wave from atrial generated ventricular contraction triggers
VSP. This ensures that pacemaker does not interfere with sinus
rhythm.
Ventricular inhibited pacemaker ( demand pacemaker)

● R wave inhibited pacemaker allows the heart to pace at tis

normal rhythm when it is able to.
● If the R wave is missing for a preset period of time, the
pacemaker will supply a stimulus.
● Hence it is called demand pacemaker
● A piezoelectric sensor is shielded inside the pacemaker casing
● When the sensor is slightly stressed or bent by patients body
activity pacemaker can automatically increase or decrease its
rate.
Atrial Synchronous Pacemaker

● Young patients with mostly stable block.

● Atrial Pacing as temporary pacing has many uses in physiologic
investigation.
● Used in stress testing and coronary artery diseases in evaluation
of severity of mitral stenosis and in evaluation of various
conduction mechanisms.
● Temporary pacemaker for atrial fibrillation.
Atrial sequential ventricular inhibited pacemaker

● Capability of stimulating both atria and ventricles and adopts its

method of stimulation to the patients needs.
● Atrial function fails, pacemaker will stimulate atrium and then
sense the subsequent ventricular beat.
● If it is working properly it discontinue its ventricular stimulating
function.
● Atrial beat is not conducted to ventricle, the pacemaker on
sensing this will fire the ventricle at a present interval of 0.12
second.
Thank you! :(