Proceedings of The 20th World Multi-Conference on Systemics, Cybernetics and Informatics (WMSCI 2016)

PACEMAKER: An Insight Into the Artificial Heart Rhythm

Lubna Moin
Department of Engineering, Faculty of Electronics and Power Engineering, PNEC, National University of Sciences and
Technology, Islamabad, Pakistan

Vali Uddin
Department of Engineering, Faculty of Engineering Science and Technology Hamdard University, Karachi, Pakistan

Bhawany Shankar Chowdhry

Department of Engineering, Faculty of Engineering Science and Technology, Mehran University, Jamshooro, Pakistan

and

Attaullah Y. Memon
Department of Engineering, Faculty of Electronics and Power Engineering, PNEC, National University of Sciences and
Technology, Islamabad, Pakistan

ABSTRACT 70-80 times per minute building up the heart beat. Figure 1
illustrates the conduction system of the heart.
A pacemaker is a small battery powered device, which paces the
heart by sending an electrical impulse, to cause rhythmical
contraction of the heart muscle. Since the first artificial
pacemaker was introduced in 1932, much has changed and will
continue to change in future. The complexity and reliability of
modern pacemakers has increased significantly, mainly due to
development in the integrated circuit design. This paper
basically will discuss the electronic perspective of the
pacemakers, the advancements done in this regard and the
ongoing research to make it more competent, capable and
useful.

Keywords: Cardiac pacemaker, integrated circuits,

electrocardiograph, biological pacemakers. Figure 1: Heart Conduction System [1]

The figure 2 drawn below illustrates a single heart beat. As

1. INTRODUCTION shown below the atrial depolarization gives rise to P wave. The
PR interval is due to the delay at AV node. It is measured from
The heart is bestowed with certain specialized cells meant for the beginning of the P wave to the beginning of the QRS
two main purposes. First purpose is to provoke the rhythmical complex. The QRS represent the rapid depolarization of the
electrical impulses that can cause co-ordinated contraction of right and the left ventricle. The ST segment delineates the
heart muscles. Second objective is the proper guidance of the depolarization of the ventricles.
conduction of these impulses rapidly through the whole heart.
Under normal conditions the atria contracts about 1/6 th of a
second before the ventricular contraction, allowing the filling of
the ventricle for further pumping. An added importance of this
system is that it allows both the ventricles to contract
proximately at the same time which is necessary for compelling
pressure of the ventricles. These specialized cells are present in
Sinoatrial SA node present in the right atrium. The signal
generated in the cells of the SA node is conducted toward left
atrium through Bachman Bundle. The signals from SA node
travels downwards through Atrioventricular AV node. The AV
node transfers the signal to the ventricles in the form of HIS
Bundles and Purkinje Fibers. So the SA node, Bachman Figure 2: Typical Electrocardiogram [1]
Bundles, HIS Bundles and Purkinje Fibers together form the
conduction system of the heart. The signal generated in the cells Lastly the ventricular contraction is depicted by R wave. The
of the SA node is conducted toward left atrium and to AV node. repolarization of ventricle is portrayed by T wave. All these
SA node is made up of a group of cells called myocytes. These waves have different voltage peaks and duration as shown in
cells contract due to depolarization and repolarization at rate of table 1 below

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Table 1: ECG Voltage Levels It was noticed by a Canadian electrical engineer John Hopps
Peak Av. Voltage Duration while investigating the upshots of radio frequency in 1941 that
if the heart abdicate generating pulses due to fall in temperature,
P 0.25mv R-P 488ms it can be proceeded to beat artificially using mechanical and
electrical stimulations.
R 1.6mv R-R 833ms This research confesses the evolution of the first cardiac
defibrillation machine in 1949. Hayman was the scientist who
designed the first experimental pacemaker in 1932. Hyman‟s
T 0.1mv-0.5mv R-T 145ms
pacemaker was powered by a hand-wound spring driven
generator that provided 6 minutes of pace making without
rewinding. The block diagram of his pacemaker is given in
figure 5, shown below.
2. ARTIFICIAL PACEMAKER Speed control

The pacemaker, or sinoatrial node, is responsible for controlling

heart rate. The cells of SA node are self firing cells. The Hand Crank Winds up Spring motor Drives Magneto-generator
depolarization and repolarization action is analogous to the ;

Drives

Current
relaxation oscillator if compared to electronic devices which is
used to produce a periodic flash from the source of light.
When the natural pacemaker does not function properly, the Impulse control Interrupter Disc

current
Pulsed
heart can suffer from arrhythmias such as bradycardia (heart
pumps too slow), tachycardia (heart pumps too fast), or
irregular heartbeats. The most common way of taking care of
Heart (Right Atrium) Stimulus Needle Electrode
these conditions is by use of an artificial pacemaker that is
implanted with the heart, shown in figure 3. Artificial
pacemakers are the electronic devices that stimulate the heart by Figure 5: Block diagram of Hyman‟s pacemaker [4]
generating electrical impulses to restore or maintain the normal
rhythm. The implanted pacemaker can send out an electrical The first implantable pacemaker was invented by Dr. Rune
impulse similar to the one a natural pacemaker. It can control Elmqvist in the year 1958. Later in 1959 engineer Wilson
the impulses sent out per minute with a computer chip and Greatbatch and the cardiologist W.M Chardack developed first
circuitry [2]. fully implantable pacemaker. Engineer Wilson Greatbatch
while modeling an oscillator to record heart sounds negligently
fitted a wrong value resistor in his circuit. The whole circuitry
began output a pulse with a steady pace, just like a beating
heart. This was the discovery of the first implantable rhythm
maker. This pacemaker basically consists of a blocking
oscillator. A blocking oscillator is a simple configuration of
discrete electronic components which produce a free running
(moving smooth and uninterrupted), signal and consist of only a
resistor, a transformer and one amplifying transistor. It is shown
in figure 6 below. Here the target of blocking oscillator is to
Figure 3: Pacemaker and leads produce a narrow pulse. The transistor of the blocking oscillator
is normally cut-off between non conduction phase of pulses and
Functionally, a pacemaker comprises at least three parts: a conducting during the time that a pulse is generated. The
electrical pulse generator, a power source (battery) and an operation of the blocking oscillator during a single cycle can be
electrode (lead) system as indicated in figure 4 [3]. classified into three phases, turn on period, pulse period and
relaxation period. Such a pacemaker is also named
asynchronous pacemakers
Power
Source

Pulse Electrodes
Generator

Figure 4: Basic pacemaker functional block diagram

3. FIRST IMPLANTABLE PACEMAKER

Figure 6: Circuitry of first implantable pacemaker

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4. DEMAND PACEMAKER
Because they are set at fixed value and do not change with
demand of the patient. The rate of asynchronous Later in 1964 Berkovits invented a demand pacemaker.
pacemaker may be altered by the physician, but once set it will Demand pacemaker provides electrical impulses only in the
continue to generate an electric pulse at regular intervals. Most absence of natural heart beat. Other important aspect of the
are set at 70 to 75 beats per minute. demand pacemaker is the life span of the battery because it is
only activated when pacing stimulus is needed [27].

Fig 7: Block diagram of demand pacemaker [30]

The demand pacemakers are designed by adding a sensing Injecting a gene TB-18 into the heart can convert heart muscle
amplifier to the asynchronous pacemakers so that it can detect cells to pacemaker cells that can initiate a heartbeat. This
congenital heart activity. This synchronous pacemaker has rate method could be useful for certain patients, such as those who
responsive pacing modalities in respect to physiological develop infections from electronic pacemakers and need to have
situations and pathological conditions [27]. the devices temporarily removed, or with life-threatening heart
disorders who cannot have an electronic pacemaker implanted.
5. LEADLESS PACEMAKER So far this technique is applied on animals and now the research
of inducing this gene into human body is in progress [26].
The entire pacemaker discussed above follow a surgical
cleavage in the chest under the collar base where the pacemaker
enduringly placed in a pocket inside the skin. The surgeon then 7. CONCLUSIONS
embeds leads from pacemaker through the veins into the right
ventricle. These leads convey electrical pulses that expedite the Artificial pacemakers are the electronic devices that stimulate
heart to beat normally [28]. the heart by generating electrical impulses to restore or maintain
Contradictory to the Conventional pacemakers, leadless pace the normal rhythm. It controls the pumping action of the heart
meters are placed directly into the heart without any surgical restoring the communication between the atria and ventricles;
cleavage and passing on leads. The leadless pace meter are therefore it increases the survival capacity tremendously. It is
much minor in size. It is a less invasive approach. It consists of used to meet the challenge of branchardia, tachyarrhythmia. It
a pulse generator that includes a battery and a steroid eluding has the sensor which itself maintains the level of periodic
electrode that sends the pulses to the heart whenever it senses signal. It basically performs the following function:
irregular heartbeats.
 Stimulate cardiac depolarization
 Sense intrinsic cardiac function
 Respond to increased metabolic demand by providing
rate responsive pacing
 Provide diagnostic information stored by the
pacemaker

The pacemaker technology is an active area of research. The

field is developing each year, starting from a lab setup of huge
pacemaker to the implantable lead pacemaker. Then the lead
less pacemakers arrived and now the biological pacemakers are
making their approach. There is also some risk or
disadvantages. Sometimes the risk factor arises due to high
Figure 8: Leadless Pacemaker [29] threshold of cardiac excitation, battery failure or
electromagnetic interference. Sometimes the air on bubble
6. BIOLOGICAL PACEMAKERS occurs in the space between lungs and chest wall. The
perforation of the heart might also take place. But new

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