Dear Editor--The cardiac stimulator described by Spicer

et al. ('Cardiac stimulator for the study of refractory period

control using current pulses of programmable duration
and shape' by M. Spicer, D. L. Pitty, K. Boone, P. Obeyesekera, D. T. Connelly, R. B. Logan-Sinclair and A. D.
Cunningham, Medical & Biological Engineering & Computing, 30, (4), 377-384) can deliver a maximum output
current of 51mA. The authors state that: 'This . . . level
may be sustained for up to 50 per cent of the time'. The
stimulating currents are unidirectional. A mean current of
25mA at the cathode represents the evolution of
2.9ram 3 H 2 per second and a very alkaline pH. Are the
authors happy about this?

Dr P. E. K. Donaldson, Implanted Devices Group, Department of Medical Physics & Bioengineering, University
College London, Shropshire House, Capper Street, London
WC1E 6JA, UK.
Received 14th September 1992
The authors' r e p l y - - D r Donaldson correctly points out
that, if used at maximum output for continuous pacing,
the current stimulator is capable of evolving H 2 at a rate
of 2.9ram 3 s -1. (His calculation is at STP; at body temperature the volume is nearer 3.3 mm 3 s-1). This will considerably raise the pH in the vicinity of the catheter tip
electrode.
Readers may like to know how the 2.9 mm 3 s- ~ figure is
derived:
(a)
(b)
(c)
(d)

25mA = 0-025Cs -1 = 1.56 x 101~electrons -1

4H + + 4 e ~ 2 H 2
1"56 x 1017electrons -1 =*, 7.8 x 1016H2molecules -1
7.8 x 1016/2.69 x 1025 (Loschmidt constant)
= 2-9mm3s -1 (@ STP)

We would like to make the following points in reply.

The programmable stimulator was designed for electrophysiology research into the effects of unidirectional
stimuli. Our immediate requirement was to generate the
long-duration, subthreshold pulses as described in Section
4 of our paper (an example of such a pulse is shown in Fig.
3). These pulses are delivered on an individual basis with
the conditioning current almost always less than 1 mA.
The high current and continuous pulsing facilities were
included in the specifications as potentially useful for
future research.
We accept that the stimulator is capable of delivering
potentially harmful pulses, when programmed to do so. It
was decided to make the stimulator as flexible as possible,
entrusting the controlling computer software to provide
any limitations to be imposed by specific research protocols.
There are many medical devices, e.g. defibrillators and
syringe pumps, that can cause damage when used carelessly. The stimulator belongs in this category and needs to
be used with care by experienced personnel. The user must
decide on the pulse characteristics and on what occasions
the pulses are to be output.
It is important to consider the inherent risks in high
current and continuous electrical stimulation and we
thank Dr Donaldson for raising an issue that we had
omitted from our paper.

M. Spicer, D. L. Pitty, K. Boone, P. Obeyesekera, D. T.

Connelly, R. B. Logan-Sinclair and A. D. Cunningham.
Mr M. Spicer, Department of Biomedical Engineering,
Royal Brompton National Heart & Lung Hospital, Sydney
Street, London SW3 6NP, UK.
Received 2nd October 1992

9 IFMBE: 1993
82

Medical & Biological Engineering & Computing

January 1993