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2 | MDT Confidential
Battery basics
Pacemaker Batteries
Separator
Negative terminal
3 | MDT Confidential
3
Pacemaker Batteries
4 | MDT Confidential
ELECTRICAL CONCEPTS
5 | MDT Confidential
Voltage
Electrical Circuit Characteristics
6 | MDT Confidential
Current
Electrical Circuit Characteristics
7 | MDT Confidential
Impedance
Electrical Circuit Characteristics
8 | MDT Confidential
Electrical Circuit Characteristics
9 | MDT Confidential
Voltage and Current Flow Electrical Analogies
10 | MDT Confidential
Resistance and Current Flow Electrical Analogies
Normal resistance – in this case the friction caused by the hose and nozzle
V
I R
12 | MDT Confidential
When Using Ohm’s Law
You Will Find That:
13 | MDT Confidential
Impedance Changes Affect Pacemaker Function and
Battery Longevity
14 | MDT Confidential
Lead Impedance Values Will Change Due to:
• Insulation breaks
• Wire fractures
15 | MDT Confidential
An Insulation Break Around the Lead Wire Can Cause
Impedance Values to Fall
16 | MDT Confidential
Insulation Break
17 | MDT Confidential
A Wire Fracture Within the Insulating Sheath May Cause Impedance
Values to Rise
18 | MDT Confidential
Lead Fracture
19 | MDT Confidential
PACING
20 | MDT Confidential
Stimulation Threshold
inimum_______
• The m_____ electrical________
stimulus needed to c_________
onsistantly capture the heart
outside of the heart’s refractory period
Capture Non-Capture
21 | MDT Confidential
Myocardial Capture
• A function of:
– Amplitude (Voltage) - the strength of the impulse:
• The amplitude of the impulse must be large enough to
cause depolarization ( i.e., to “capture” the heart)
• The amplitude of the impulse must be sufficient to provide
an appropriate pacing safety margin
– Pulse width - the duration of the current flow expressed in
ms
• The pulse width must be long enough for depolarization to
disperse to the surrounding tissue
22 | MDT Confidential
The Strength-Duration Curve
Volts
1.0
– Any combination of pulse
width and voltage on or Capture
.50
above
the curve will result .25 No - Capture
in capture
0.5 1.0 1.5
Pulse Width
23 | MDT Confidential
Clinical Utility
of the Strength-Duration Curve
24 | MDT Confidential
Effect of lead design on capture
• Lead maturation
– Fibrotic “capsule” develops around the electrode following
lead implantation
– May gradually raise threshold
– Usually no measurable effect on Impedance
25 | MDT Confidential
Steroid Eluting Leads
Porous, platinized tip
for steroid elution
• Steroid eluting leads
reduce the inflammatory
process
– Exhibit little to no acute
stimulation threshold
peaking
– Leads maintain low
chronic thresholds Tines for
Silicone rubber plug stable
containing steroid fixation
26 | MDT Confidential
Effect of Steroid on Stimulation Thresholds
5
3
Volts
1
Steroid-Eluting Electrode
0
0 1 2 3 4 5 6 7 8 9 10 11 12
Implant Time (Weeks)
27 | MDT Confidential
Pulse Width = 0.5 msec
Capture Hysteresis (The Wedensky Effect)
28 | MDT Confidential
SENSING
29 | MDT Confidential
Pacemaker Sensing
• Refers to the ability of the pacemaker to “see”
signals
– Expressed in millivolts (mV)
• The millivolts (mV) refers to the size of the signal
the pacemaker is able to “see”
0.5 mV signal
2.0 mV signal
30 | MDT Confidential
3
Sensitivity – the value we program into the
IPG
5.0 mV
2.5 mV
1.25 mV
Time
31 | MDT Confidential
Sensing Amplifiers/Filters
• Accurate sensing requires that extraneous signals are
filtered out
– Because whatever a pacemaker senses is by definition a P-
or an R-wave
– Sensing amplifiers use filters that allow appropriate sensing of P
waves and R waves and reject inappropriate signals
32 | MDT Confidential
Pacemaker sensing
33 | MDT Confidential
POLARIZATION
34 | MDT Confidential
Polarization
- +
-
+ + + -
+ +
Current + - Current Tissue
+ -
+ + +
+
- -
36 | MDT Confidential
ICD Battery Design
• Lithium/Silver Vanadium Oxide
• Anode: Lithium
• Cathode: Silver Vanadium Oxide
• Electrically Insulated via Porous separator
• Porous Separator allows ions Flow.
• High Power to Achieve Short Charge time, High
surface area
37 | MDT Confidential
ICD Sensing
38 | MDT Confidential
Auto-Adjusting Sensitivity
Ventricular
Programmed Sensitivity
39 | MDT Confidential
Auto-Adjusting Sensitivity
Atrial
Programmed Sensitivity
40 | MDT Confidential
Defibrillation Threshold
42 | MDT Confidential
Pacing
No capture Capture
43 | MDT Confidential
Defibrillation
Almost
May or Almost
certainly
may not certainly will
won’t
defibrillate defibrillate
defibrillate
44 | MDT Confidential
Shock characteristic
• Other Considerations:
– Shock delivery waveform
• Monophasic – energy flows in one direction during
discharge
• Biphasic – energy reverses direction during discharge
45 | MDT Confidential
Biphasic Shock
• Lower defibrillation thresholds
• Higher implant success rates
• Reduced short-term myocardial injury
• Faster return to sinus rhythm post-shock
46 | MDT Confidential
Shock Vectors
• HVA / HVX to HVB or
• HVB to HVA / HVX
A A
B
B
47 | MDT Confidential
Tissue Impedance
ICDs have a
capacitor system
which generates a
voltage between
the can and the coil
ΔV
48 | MDT Confidential
Tissue Impedance
The voltage gradient
results in current flow
The size of the current
depends on the tissue
impedance
Also known as the
“Shock impedance”
High impedance- low
current
Low impedance- high I
current
o Shock Impedance is smaller then
the Pacing Impedance
o Range: 50 – 200 Ohms
49 | MDT Confidential
Tissue Impedance
50 | MDT Confidential
Tissue Impedance
Additional elements in
the circuit can reduce the
overall impedance and
increase current flow
SVC coil
SQ array
Epicardial patch
Hence DFT can be I
lowered
51 | MDT Confidential
Current shunting
Additional elements in
the circuit may direct
current away from the
heart
Impedance may be low I
and current high but
energy never gets to
myocardium
For example
SVC coil in RA
Retained pacing wires/
stylets
52 | MDT Confidential
Thank You
• Any Questions
53 | MDT Confidential