 It is an electrical pulse generator for starting

and/or maintaining the normal heart beat

 The various arrythmias that result in heart

block and adams stokes attacks in patients

leads to losing consciousness
 By use of this artificial pacemaker, the abov

defects in heart can be eliminated

 Even in drug therapy the failure within the

year is about 50%, but in this therapy lowers

to 15%...
 Like all miscle tissue, the heart muscle can be
stimulated with an electric shoch, the min
energy required is about 10microJ
 For better stimulation, energy at range of
100microJ is applied that is a pulse of 5 V,
10mA for 2 millisec is used
 These pulses should have the pulse to space
ratio 1:10000
 The pulse repetition rate is usually 70
pulses/min but many PM are adjustable range
of 50-150 pulses/min
 Pacemaker pulse

Typical range of pacemaker parameter

Pulse rate -25-155 pulses/min
pulse width -0.1-2.3 millisec
pulse amplitude -2.5-10 volt
battery capacity -0.44-3.2 -amp-hour
weight -33-98 grams
size -22-80 cm3
encapsulization -silicon rubber, stainless
steel,titanium
 Pacing or stimulation can be classified into two types as
follows.,
 EXTERNAL stimulation is employed to restart the
normal rhythm of heart in the case of cardiac stand still
 energy to this type of electrode is in the range of 20-
510 mA
 INTERNAL stimulation is employed in cases requiring
long term pacing due to permanent damage that
prevents normal self triggering of heart
 Current for this electrode will range from 2-15mA
External pacemaker
 Pacemakers are placed outside
the body, it may be in the form
of wrist watch or in pocket,
form that a wire will go into
heart through a vein
 The electrodes are called
ENDOCARDIAC
 It does not necessiate the open
chest surgery
 During placement swelling and
pain do not arise to min foreign
body reaction
 Here there is no safety for the
pacemaker
 Mostly these are used for
temporary heart irregularities
Internal pacemaker
 The pacemaker is miniaturized
and is surgically implanted
beneath the skin near to chest
or abdomen with its o/p leads
are connected to the heart
muscle
 The electrodes are called as
MYOCARDIAC
 It requires an open chest
surgery to place the circuit
 During placement swelling and
pain arise due to foreign
material reaction
 Here there is cent percent
safety for the circuit from
external damage
 Mostly these are used for
permanent heart damages
 Based on the mode of operation of the
pacemaker, they can be divided into five
types.,
* Ventricular asynchronous pacemaker
* Ventricular synchronous pacemaker
* Ventricular inhibited pacemaker
* Atrial synchronous pacemaker
* Atrial sequential Ventricular inhibited
pacemaker
 This pacemakers are used for patients with either a stable,
total AV block, a slow atrial rate or atrial arrhythmia
 This the 1st PM that can be used in atrium or ventricle
 It is similar to a simple ASTABLE MULTIVIBRATOR, this
produces a stimulus at a fixed rate similar to heart rhythm
 In earlier days, TV type of blocking oscillator with a
transformer was used to generate stimulus,
 But now-a-days fixed rate generator fabricated on a single
chip with square wave generator is used along with a
positive triggered monostable multivibrator
 A square wave generator is designed using a 1 microF
and a resistor of 500 Kohmwith a voltage detector
circuit
 The O/P of this unit provides a positively and negatively
going square wave with equal duration for positive and
negative pulse
The period of square wave generator is given by

where

 According to the fig., T=0.8589 sec , the value can be

changed by changing the value or the value of time
constant RC
 The max O/P voltage is equal to
 The square wave generator is a astable multivibrator
which periodically switches between the O/P voltage
and -
 the O/P of a square generator is coupled to the positive
edge triggered monostable multivibrator
 The I/P in the positive trigger will pass through the
capacitor Cc and the diode
 The capacitor Cc is chosen to make five time equal value
to the pulse duration TD

= 5*0.16*10^-6[1200/2.2]
= 0.437 milli sec
 Thus this PM can delivers the pulse with period T=0.8589
sec and pulse duration TD = 0.437 milli sec
 Using a fixed rate pacemaker, the heart rate
cannot be increased to match greater
physical effort
 Stimulation with a fixed impulse frequency

results in the ventricle and atria beating at

different rates
 Possibility for ventricular fibrillation will be

more.
 This type pacemakers are used for patient with short time
AV block or bundle block, usually this type does not
compete with the normal heart activity
 Separate sensing electrode is not needed, since a single
electrode placed at the right ventricle both sense the R-
wave and delivers the stimulation
 The R-wave from the atrial generated ventricular
contraction triggers the pacemaker which provides an
impulse falling in the lower part of the normal QRS complex
 If R-wave from the atrial generated ventricular contraction
absent , then the pacemaker provides impulse at the
frequeny of 70 impulse/min.
 Using the sensing electrode, the heart rate is detected
and it is given to the timing circuit in the pacemaker, if
the detected rate of the heart is below a certain min
level, the fixed rate pacemaker is turned on to pace the
heart
 The lead used to detect the R wave is now used to
stimulate the heart, if a natural contraction occurs, the
PM timing circuit is reset so that it will time its next
pulse to detect heart beat
 Suppose the pacemaker may detect the noise and
interpret as its ventricular excitation, but it is
eliminated by the incorporation of refractory period
circuit
 In heart blocks P wave occurs randomly, by using a high
pass filter with lower cut off frequency at 20 Hz will
eliminates the P wave
 To arrest the ventricular fibrillation, this
circuit can be used
 The power consumption is reduced and there

is no chance of getting side effects due to

competition between natural and artificial
pacemaker pulses. When R wave is appearing
with lesser amplitude, the circuit amplifies it
and delivers it in proper. If the R wave period
is too low or too high, the asynchronous pacer
in the circuit is working upto the returning of
the heart into normal one.
 Atrial and ventricular contraction are not
synchronized
 The olden type pacemakers are more sensitive

to external electromagnetic interference such

as microwave ovens, security metal detector
and so on., thus the patients could not work in
radio or T.V. they could not undergo diathermy
treatment and further could not ride motor or
scooters
 In previous type of pacemaker if the R wave is
present then the stimulus is generated, but in
this type if the R wave is missing for a preset
period of time the pacer will supply a stimulus
 Therefore if the heart rate falls below a

predetermined min the pacer will turn on and

provide the heart a stimulus, hence it is called
as “Demand pacemaker”
 It uses a piezoelectric sensor, which senses

each activity of the patient and automatically

increases or decreases its rate
 This type of pacemaker is used for young
patient with a mostly stable block, it has many
uses in physiologic investigation. It can act as
a temporary pacer for atrial fibrillation
 The atrial activity is picked up by a sensing
electrode placed in a tissue close to the dorsal
wall of the atrium. The detected p wave is
amplitude and a delay of 0.12sec is provided
by the AV delay circuit
 The signal is then given to trigger the
resetable multivibrator and the O/P is given to
the amplifier which produces the desired
stimulus to be applied to the heart. The
stimulus is delivered to the ventricle by a
ventricular electrode
 It has the capacity of stimulating both the
atria and ventricle and adopts its method of
stimulating to the patients need
 If the atrial function fails this pacer will

stimulate the atrium and then sense the

subsequent ventricular beat, if is works
properly it will discontinue its ventricular
stimulating function
 However if the atrial beat is not conducted to

the ventricle on sensing this will fire the

ventricle at a preset interval of 0.12sec
 Now-a-days the “programmable pacemakers”
which can work in any mode depending upon
the patients need are available
 A magnet is placed over the pacer on the skin

of the patient in order to activate a reed

switch the pacer into any of the modes
discussed so far
 Further this type of pacer facilitates to change

the pulse rate, pulse amplitude and pulse

width by external coded impulse, by using this
type any alteration can be done immediately
in the case of emergency.