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Cardiac Pacemakers

Cardiac pacemakers are devices that generate artificial pacing impulses to regulate heartbeats, consisting of components like a pulse generator, electrodes, and a battery. There are internal and external pacemakers, with various pacing modes including asynchronous, synchronous, inhibited, and sequential types. Each type serves different cardiac conditions, with specific advantages and disadvantages regarding functionality and patient needs.

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9 views20 pages

Cardiac Pacemakers

Cardiac pacemakers are devices that generate artificial pacing impulses to regulate heartbeats, consisting of components like a pulse generator, electrodes, and a battery. There are internal and external pacemakers, with various pacing modes including asynchronous, synchronous, inhibited, and sequential types. Each type serves different cardiac conditions, with specific advantages and disadvantages regarding functionality and patient needs.

Uploaded by

sanjaylogesh14
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CARDIAC PACEMAKERS

CARDIAC PACEMAKERS
Definition:
A device capable of generating artificial pacing impulses and delivering them to
heart is known as pacemaker system or pacemaker.
Sino Atrial node - Natural Pacemaker is responsible for the starting of heart beat

COMPONENTS OF PACEMAKER
➢ Pulse generator
➢ Electrodes
➢ Battery

METHODS OF STIMULATION OF PACEMAKER


• External stimulation- Used to restart the normal rhythm of the heart in case of
cardiac standstill (no movement or activity occurs during heart operation or
sudden shock)
• Internal stimulation-It prevents normal self triggering of the heart.(permanent
damage)
Types of pacemakers:
➢ Internal pacemaker
➢ External pacemaker
INTERNAL PACEMAKER
• It is placed inside the body. It may be
permanently implanted on the patients whose SA
nodes are failed to function or those who
suffered from permanent heart block
• Internal pacemaker systems are implanted with
the pulse generator placed in a surgically
developed pocket below the right or left clavicle
(collar bone), in left sub costal region
• Internal leads are connected to the electrodes
that directly contact the surface of the
myocardium.
INTERNAL PACEMAKER
• The exact location of the pulse generator used in
the internal pacemaker system depends on the
following factors.
➢Type and nature of the electrode used.
➢Nature of the cardiac problems.
➢Mode of operation of the pacemaker system.
• There is no external connection for applying
power. So the pulse generator should be
completely self contained with a battery, which is
capable of operating continuously for a specified
period.
EXTERNAL PACEMAKER
• It consists of an externally placed pulse generator circuit
connected to the electrodes placed on the myocardium.
• Temporary heart irregularities or disorders.
• Treating the patient from arrhythmias (abnormal heart
rhythm).
• Treatment of coronary patient and during the cardiac
surgery.
• It consists of pulse generators. They are placed in the body
and connected normally to the electrode with the help of
wires introduced into the right ventricle.
• The pulse generator may be strapped to the lower arm of
the patient.
TYPES OF PACING MODES
TYPES OF PACING MODES
Five types
• VENTRICULAR ASYNCHRONOUS PACEMAKER (FIXED
RATE PACEMAKER)
• VENTRICULAR SYNCHRONOUS PACEMAKER (STANDBY
PACEMAKER)
• VENTRICULAR INHIBITED PACEMAKER (DEMAND
PACEMAKER)
• ATRIAL SYNCHRONOUS PACEMAKER
• ATRIAL SEQUENTIAL VENTRICULAR INHIBITED
PACEMAKER
VENTRICULAR ASYNCHRONOUS PACEMAKER (FIXED RATE
PACEMAKER)
• It can be implemented in atrium or ventricle.
• Suitable for patients who are suffered by total AV block, atrial arrhythmia.
It consists –
• square wave generator – astable multivibrator which periodically
switches the voltage in o/p b/w Vsat and -Vsat
• monostable multivibrator circuit – positive edge triggered -
positive step at the trigger input will pass through the Cc and
diode will raise the non inverting terminal of the differential
amplifier)
The period square Wave generator is given as T.
• T=-2(RC) ln((1 – α)/(1+ α))
α – feedback voltage friction
α = R2/(R1+R2)
• T= 0.8589 seconds
• Pulse duration ,
TD = 5Cc [R4 R3/R3+R4] = -R5 Cm ln(R3/(R3+R4))
TD = 0.437 milliseconds
• Thus this pace maker can deliver the pulses with the period , T= 0.8589
seconds and pulse duration TD = 0.437 milliseconds
VENTRICULAR ASYNCHRONOUS PACEMAKER (FIXED RATE
PACEMAKER)
VENTRICULAR ASYNCHRONOUS PACEMAKER

• Disadvantages:
• Heart beat rate cannot be changed.
• If it is fixed in atrium, atrium beat at a fixed rate. If
ventricle beat at a different rate, and then it leads to a
severe problem. Ventricular fibrillation may be
occurred.
VENTRICULAR SYNCHRONOUS
PACEMAKER (STANDBY PACEMAKER)
• Suitable for the patients who are suffered by
short period of AV block.
• Electrode placed in the right ventricle of
heart. This electrode is used to sense the R-
wave.
• If ventricular contractions are absent, then the
pacemaker provides the impulses.
• This type of pacemaker does not compete
with the normal heart activity.
VENTRICULAR SYNCHRONOUS PACEMAKER (STANDBY
PACEMAKER)

• Electrode is used to detect the heart rate and it is given to the


amplifier and filter circuit. Because heart rate amplitude is very
low. Amplifier is used to amplify the cardiac signal. Filter is
used to remove unwanted noise signal.
• Signal is given to refractory period control and timing circuit.
• R-wave is below the certain level, at that time only, this
pacemaker will deliver the pulses.
VENTRICULAR SYNCHRONOUS PACEMAKER (STANDBY
PACEMAKER)

• Advantages:
• Ventricular fibrillation is avoided.
• When R-wave is normal , then fixed rate pacemaker
block is not in ON condition, so power consumption is
reduced.
• Disadvantages:
• Very sensitive to electromagnetic interferences.
• No synchronization between atrial and ventricular
contraction
VENTRICULAR INHIBITED PACEMAKER (DEMAND PACEMAKER)
• Comparator determines the pacing rate of the pulse generator.
• pulse width circuit - determines the duration of the stimulating
pulses.
• Rate limiting circuit - disables the comparator for a short interval and
limits the pacing rate.
• Output circuit - provides a voltage pulse to stimulate the heart.
• Voltage monitor circuit - senses the cell depletion and controls the rate
slow down circuit and energy compensation circuit.
• Rate slow down circuit - shuts off some current to the basic timing to
slow down pulse rate during cell depletion.
• Energy compensation circuit - produce an increase in pulse duration
as battery voltage decreases to maintain constant simulation energy to
heart.
• Sensing circuit - detects a spontaneous R-wave and resets the
oscillator timing capacitor.
• Reversion circuit - helps the amplifier to detect spontaneous R wave in
the presence of low level continuous wave interference.
• In the absence of R wave the circuit allows the oscillator to produce pacing
pulses at its present rate.
• The inhibited pacemaker allows the heart to pace at its normal rhythm
when it is able to do.
• If the R wave is missing for a preset period of time, then the pacemaker
will turn ON and provide the heart a stimulus. Hence it is termed as
Demand pacemaker.
ATRIAL SYNCHRONOUS PACEMAKER
• P wave is sensed and picked by the electrode
fixed on the atrium. It is given to the amplifier
circuit.
• Amplifier circuit is used to amplify the P-
waveform.
• Circuit is used to give the delay 0.12 second.
ATRIAL SYNCHRONOUS PACEMAKER
• The output of the delay circuit given to refractory
control and preset multivibrator block.
• If the P wave amplitude is not in normal value,
then fixed rate pacemaker will turn ON. When P-
wave amplitude is normal, then fixed rate
pacemaker is OFF.
• If fixed rate pacemaker is ON, then the output is
given to amplifier. The amplified signal is given to
ventricle through electrode.
• Refractory control circuit provide some time
delay, because pacemaker pulse is too large.
ATRIAL SEQUENTIAL VENTRICULAR
INHIBITED PACEMAKER
• It is used to stimulate both atrial and ventricles. It
is a demand pacemaker, so based on the patients
need, it provides the impulses.
• In the modern pacemakers, magnet is placed
over the pacemaker on the skin of the patient to
activate the reed switch. This switch, switches the
pacemaker into any one of the mode of
operation, either to give the impulse for atrial or
to ventricle.

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