SEMINAR ON ARTIFICIAL PACEMAKER

What is a pacemaker?

Artificial pacemakers are a two-part electrical system that includes a pulse generator (pacemaker) and one or two leads which deliver impulses to the heart. The leads also carry signals back from the heart. By "reading" these signals, the pulse generator is able to monitor the heart's activity and respond appropriately. A pacemaker helps to pace the heart when the natural rate is too slow to pump enough blood to the body (bradycardia).

Pacing Systems
Pulse generator

Sensing and Pacing lead

Pulse generator
Pulse generator is responsible for generating the pulse at the proper time based on events sensed Main elements: Power source provide the energy required for the operation of the pacemaker

Memory (RAM/ROM) to store data for diagnostic purposes Antenna. Monitors relevant heart data and sends it, for example, to doctor Microprocessor controls all operations

Pacing Lead

The generator is connected to heart through the tiny wires called leads. Connector Leads deliver the pulse to its destination in the heart, sense and carry back information to the pulse generator. Each lead has an electrode on its tip. That tip actually burrows into heart wall

Lead Body

Active Fixation Mechanism

Tip Electrode

Fixation Mechanisms

Good contact with the heart wall. Achieve best results in pulse pacing of the heart

Electrode

Effective interface between two systems, physiology and electronics, can be done with electrode Material used for electrode tips is titanium Electrode housing is made from silicone rubbers Steroids needed to prevent inflammation process

Inflammation process when, human body attempts to isolate a foreign object (est. pletik)

How a healthy heart works?

The heart is a double pump that circulates blood around the body. It has four chambers. The upper right chamber (right atrium) and lower right chamber (right ventricle) take in deoxygenated blood from the body and send it to the lungs. The upper left chamber (left atrium) and the lower left chamber (left ventricle) take in oxygenated blood from the lungs and send it around the body. The ventricles do all the pumping. The nervous system is responsible for the heart rate and coordinating the heart's pumping action

How does a pacemaker take over heart beat?

The pacer's electrical pulses travel through leads to heart. The pulses are timed to flow at regular intervals just like heart's natural electrical signals would. Pacer has 2 functions: pacing and sensing (The third function is programming)

Pacing Pacer sends electrical signals to heart through pacing leads. Each electrical signal is called a pacing pulse. The pacing pulse begins heart beat Sensing Leads send information about heart's electrical system back to the pacer. This allows the pacer not to interfere with a natural, healthy heart beat Sensing Functions: - Level detection (amplitude) - Filter (band-pass filter) - Amplifier

Picture illustrates how pacemaker is connected to the heart and take control over heart`s beat

Types of artificial cardiac pacemakers

Unipolar system Single chamber - only one chamber is regulated Bipolar system Dual chamber - two leads are used.

Implantation procedure

The procedure is usually done under local anaesthesia The pulse generator is implanted under the skin The leads are inserted using xray control, via a vein found in this area, and positioned in the appropriate right sided heart chamber The leads are tested before the pulse generator is attached

Programming

Pacemakers have many programmable functions that can be done with a special programmer. Unfortunately there is no universal programmer and each manufacturer provides programmers that will work only with their pacemakers

Living with an artificial cardiac pacemaker

A person with an artificial cardiac pacemaker can live a normal life and can still do everyday activities. Most pacemakers last longer than five years. Before the pacemaker fails, a battery depletion indicator suggests that the pacemaker should be replaced. This is again performed under local anaesthesia.

How does magnet application affect a pacemaker?

Magnet application disables the sensing amplifier, causing it to pace asynchronously. It is recommended that patients with a pacemaker keep at least 15 cm away from possible sources of magnetic interference, e.g. mobile phones, magnetic pain therapy, stereo speakers

First pacemakers

A model of Albert Hymans Pacemaker (1931)

First totally implantable pacemaker by Senning (1958)

The battery operated pacemaker by Lillehei and Bakken (1957)

Referance
1.

Berg, Linda R., Martin, Diana W., and Solomon, Eldra P. Biology: Sixth Edition. Ed. Nedah Rose. Thomson Learning Inc., 2002, pp. 923 928 Crane, Richard H. Some of the Physics of Cardiac Pacemakers. How Do Things Work (1983 1995). American Association of Physics Teachers., 1996, pp. 41 42. Sutton, Caroline. How Does an Artificial Pacemaker Help a Weak or Damaged Heart?. How Do They Do That? : Wonders of the Modern World Explained. Ed. Duncan M. Anderson. Hiltown Press Inc., 1981, pp. 28 30 http://heartdisease.about.com/cs/arrhythmias/a/pacemakers.htm http://www.tucsonheart.com/pacemaker_insertion.htm

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