Our heart has its own internal electrical system that controls the rate and rhythm of our heartbeat. With each heartbeat, an electrical signal spreads from the top of our heart to the bottom. As the signal travels, it causes the heart to contract and pump blood. Each electrical signal normally begins in a group of cells called the sinus node or sinoatrial (SA) node. As the signal spreads from the top of the heart to the bottom, it coordinates the timing of heart cell activity.
First, the heart's two upper chambers, the atria contract. This contraction pumps blood into the heart's two lower chambers, the ventricles. The ventricles then contract and pump blood to the rest of the body. The combined contraction of the atria and ventricles is a heartbeat. What is a natural pacemaker? The heart's "natural" pacemaker is called the sinoatrial (SA) node or sinus node. It's a small mass of specialized cells in the top of the heart's right atrium (upper chamber). It makes the electrical impulses that cause your heart to beat. A chamber of the heart contracts when an electrical impulse moves across it. For the heart to beat properly, the signal must travel down a specific path to reach the ventricles, the heart's lower (pumping) chambers. The natural pacemaker may be defective, causing the heartbeat to be too fast, too slow or irregular. The heart's electrical pathways also may be blocked. What is an artificial pacemaker? Cardiac pacemakers are generally used to manage a slow or irregular heart rate. The pacemaker system applies precisely timed electrical signals to induce heart muscle contraction and cause the heart to beat in a manner very similar to a naturally occurring heart rhythm. A pacemaker consists of a pulse generator, at least one electrode, and one or two pacing leads connecting the pacemaker to the heart. The casing of the pulse generator functions as housing for the battery and circuits, which provide power.
It is usually implanted between the skin and pectoral muscle. The sealed lithium iodine battery provides electrical energy to the pacemaker. This battery replaced the mercury-zinc battery in 1975, extending the life of some pacemaker models by over 10 yr. The circuitry converts the electrical energy to small electrical signals.
Pacemaker electronics Basic blocks of implantable pacemakers consist of ECG front end circuitry, ultra low power microcontroller, battery and output circuitry to stimulate heart. Heart signal is sensed by electrodes. Main emphasis must be given on size, weight, encapsulating material and increase in life span of battery up to 10 to 12 years. The front end senses voltage generated by the pumping action of the heart which is small signal with many noise components. This circuit consists of differential amplifier, filter, level shifter, synchronizing circuit etc. To pace abnormal heart with a pulse of 5 to 7.5 volts, multiplier along with switch network is used. Implantable pacemaker consists of external comparator. Cardiac signal is sensed by unipolar or bipolar electrodes and is amplified by a low noise pre-amplifier, gain amplifier. It is filtered by second order low pass filter to get appropriate ECG. This signal is applied to the comparator. Comparator is used as a threshold detector, to detect the heart beat event executed by the heart and generates a pulse with every heartbeat. External comparator consists of two inputs i.e. ECG and threshold voltage. It generates pulse depending on the threshold voltage level. Output stage called charge pump, consists of voltage multiplier/pulse generator to stimulate heart. A high voltage pulse of 5 to 7.5Volts is delivered to the heart through pacing electrodes. The amplitude and pulse width must be customized for each patient. Supply Voltage Supervisor (SVS) is necessary to monitor battery voltage.
A typical block diagram VLSI based analog/digital custom processor and interfacing peripherals are used in implantable pacemakers . Some ultra low power microcontrollers are available today which will be better choice for crucial biomedical applications.Pacemaker is a computer controlled real time system with predefined tasks priority. Microcontroller with optimized software is basic component in it. Microcontroller to be chosen must have low power consumption and required memory space. Components and Materials of Construction A connector block, made of polyurethane, is located at the top of the pacemaker. It serves to attach the pacemaker to the pacemaker lead. Formerly, glass materials were used to comprise the connector block. The pulse generator is encased in ASTM grade1 titanium. Titanium replaced ceramics and epoxy resin, which were used for encapsulation of some pacemakers in the past, with silicone rubber. This upgrade to titanium allowed patients to safely use appliances such as microwave ovens, because titanium helps to shield the internal components and reduce the external electromagnetic interference. A pacing lead is vital to the pacemaker system, because it transmits the electrical signal from the pacemaker to the heart and information on the heart activity back to the pacemaker. One or two leads may be used, depending on the type of pacemaker. One end of the lead is attached to the connector block of the pacemaker. The other end is inserted through a vein and placed in the right ventricle or right atrium of the heart. The lead is an insulated wire consisting of a connector pin, lead body, fixation mechanism and at least one electrode. The connector pin is the portion of the lead that is inserted into the connector block. The lead body is the insulated metal wire that carries electrical energy from the pacemaker to the heart. The lead must be able to withstand the flexing induced by the cardiac contractions in the warm and corrosive environment in the body. Thus, the materials used must be inert, nontoxic, and durable. The lead body must be flexible, noncorrosive, and durable. It must also be a good electrical conductor. The early lead body was insulated with polyethylene. Currently, the lead body is insulated with a more resilient material such as silicone rubber tubing or polyurethanes. Polyurethanes are generally stronger than silicone rubbers, which are easily damaged. The strength of polyurethanes enables a thinner lead to be used in the pacemaker and offers greater lead flexibility. Another advantage of polyurethanes is their very low coefficient of friction when wet. However, metal-ion-induced oxidation may degrade polyurethanes, while silicones are not affected by this mechanism of degradation. The fixation mechanism serves to hold the tip of the lead in place in the heart. Currently, either a nickel-cobalt alloy with a silver core helix or an electrically active platinum-iridium helix may be used to anchor the electrode of the lead to the surface of the heart. The electrode is located at the tip of the lead. It serves to deliver the electrical energy from the pacemaker to the heart and information about the natural activity of the heart back to the pacemaker. Electrodes may be composed of platinum, titanium, stainless steel, silver, or cobalt alloys. Titanium has been used because it forms a nonconducting oxide layer at the surface. This surface prevents the exchange of charge carriers across the boundary. Titanium also exhibits a high modulus of elasticity, high resistance to corrosion, and high durability. Electrodes may be coated with iridium oxide to prevent nonconductive layers from forming. The coated electrodes may also provide lower acute and chronic thresholds due to the reduced local inflammation. Drug-Eluting Leads. Leads have developed immensely since they were first introduced. The earliest leads were attached to the outer surface of the heart.
In the mid-1960s, transverse leads were introduced. They could be inserted through a vein leading to the heart, thus eliminating the need to open the chest cavity during implantation. In the 1970s, tined and active fixation leads were developed to replace smooth tip leads. The prongs on the tined leads and the titanium alloy screws in the active fixation leads provide a more secure attachment to the heart and are still used today. Trends lead-less pacemakers This is the Medtronic wireless pacemaker, just revealed at TEDMED 2010, which can be implanted directly into our heart via catheter and permanently latch itself into flesh with tiny claws. Then, doctors can wirelessly monitor and even control the device from a nearby phone.
Nuclear battery The nuclear battery in Medtronic device had used metallic Plutonium (Pu 238).The radiation produced by Plutonium bombarded the walls of its container. Then the heat was converted to an electric current by a thermopile. A thermopile is a stack of thermocouples. Those thermocouples directly converted the heat into electricity using Seebeck effect. Battery-free pacemakers Now there are so many researches going under this topic and there are evolving methods. One such method is combining the implanted device with a microgenerator producing electricity every time the patient moves, effectively eliminating the need for an internal battery. wireless pacemakers These are the pacemakers that communicate wirelessly with a monitoring service, which is in turn accessed daily by the doctor. The device can be reprogrammed using wireless signals. This method reduces the no of surgeries that the patient has to undergo. SMS-capable pacemakers The latest application is an SMS-enabled pacemaker that can automatically send messages to a cardiologist's cellphone, allowing the doctor to monitor a patient's condition. The unit was developed by Dutch manufacturer Biotronik, and the first implant was performed at VU University Medical Center in Amsterdam. Hacking risks to heart devices Devices are used to wirelessly communicate with the implanted defibrillator or pacemaker. Those devices are obviously only sold directly to physicians by a select group of companies but, as the researchers warn, it is at least conceivable that hackers could transmit the same radio signals using another device, allowing them to shut down the defibrillator or deliver a shock, or possibly even obtain a patient's medical information.