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CARDIAC PACEMAKERS
• Pacemakers are the device that is capable of producing
artificial pulse for the heart to work normally. It has two main
components as Generator and Electrodes.
• Pulse generator should develop pulse at a ratio 1:10000. It
should be capable to produce negative pulse to avoid muscle
ionization. The pulses produced are variable in nature, such
that energy given to the heart can be controlled.
• Duration of each pulse is 1 to 2 milli seconds. The pulse
repetition rate is 70 pulses/min. usually unipolar or bipolar
electrodes are chosen for electrode setup.
• The electrical stimulation to the pacemaker can be of two
type’s external and internal stimulation. There are different
types of batteries used namely Mercury cell, Lithium cells and
rechargeable batteries.
Types of Pacemakers
• Internal Pacemakers
• The entire unit is placed inside the human body. It is used for the
patient whose SA node has completely failed to function or for who
suffers from heart block. The device is placed with a surgery. Pulse
generator is placed in a pocket below right or left clavicle. For women it
is placed near pectoral muscle. Electrodes are connected to the
generator, and they contact the myocardium directly. The location of
pacemaker depends on the factor like Nature of heart disease, type of
electrode used and pacemaker operation mode. This does not have
external power supply. It already consists of battery that can work
continuously for a time.
• External Pacemakers
• Here external pulse generator circuit and electrode are used. They are
placed inside myocardium. This type id suitable for patient who suffers
from temporary heart block and disorders. It is very importantly used
for patients who suffer from arthymias and coronary disease. Since the
generator is placed external, they are connected to electrodes via wires
and introduced into ventricles. The setup is attached with belt on the
lower arm of the patient.
Pacing Modes of Operation in a
Pacemaker
• The pacing modes of the pacemaker are classified as Competitive
and Non – competitive modes.
• Competitive Mode of the Pacemaker(ASYNCHRONOUS)
• The competitive mode of pulse generators produces fixed rate pulses
that are independent of natural cardiac activity. Instead, the fixed rate
pulses are generated alongside with heart’s natural pulses. It
competes with them to control the heartbeat. This fixed rate
pacemakers are implanted for the patient whose SA node has failed
from its operation. The disadvantage of this type is less battery life.
• Non – Competitive Mode of the Pacemaker(SYNCHRONOUS)
• This type of pacing mode either generates ventricular programmed or
atrial programmed pulses. Among these, the ventricular-programmed
pacemaker will operate in either demand mode (R wave stopped) or
standby mode (R wave triggers). Atrial programmed pacemaker works
in synchronization with P wave of ECG waveform.
Ventricular Asynchronous Pacemaker
(Fixed Rate Pacemaker)
• This type of pacemaker is installed in atrium or ventricles
for the patients who suffer from total AV block and atrial
arrhythmia. The generated impulses and normal heartbeat
competes with each other. When looking into the electrical
circuit of the pacemaker it has square wave generator and
monostable multivibrators.
• DESIGN
Disadvantage:
• In this type of pacemaker heartbeat cannot be altered.
• When the impulse in atrium and ventricles beats at
different rate ventricular fibrillation occurs.
Ventricular Synchronous Pacemaker
(Standby Pacemaker)
• This type of pacemaker is used for patients who suffer from a short
period of AV block. The electrode is placed in the right ventricle and
it senses R wave. R wave triggers the pacemaker. The detected
signal is given to amplifier and filter circuit. this pacemaker does not
compete with normal heart beat signal. Filters remove the
unwanted noise signal, hence P wave is removed. The obtained
signal is given to the refractory period and timing circuit. If it
detects heartbeat below a particular level, fixed rate pacemaker
block is turned on. The impulses from fixed rate pacemaker is
amplified and given through electrode. On the other case, if
heartbeat is normal fixed rate pacemaker block is not turned on.
The pacemaker delivers impulses only when R wave is detected and
remains at certain level. This type of pacemaker avoids ventricular
fibrillation.
Ventricular Inhibited Pacemaker
(Demand Pacemaker)
• The timing circuit consists of RC network, reference voltage source
and a comparator. Comparator is used to determine the pacing rate
of generator. The obtained output is given to the second RC network.
• The duration of stimulating pulse is determined with pulse width
circuit. After this, the signal goes to the third RC network, which is
rate-limiting circuit. It disables comparator and helps to limit pacing
rate.
• The final output obtained is given as impulse for stimulating heart.
• Voltage monitor circuit controls the rate and used as energy
compensation circuit. Rate slow down circuit stops amount of
current that goes to the basic timing. This helps to slow down the
pulse rate during depletion of cell.
• Sensing circuit identifies R wave and resets the oscillator timing of
capacitor. When R wave is absent, the oscillator in the circuit
produces pulses at preset rate.
• The inhibited pacemaker makes heart to produce pulse that can beat
at its own rhythm whenever possible. When R wave is missing for a
short time period, pacemaker will turn ON to produce stimulus for
heart. Hence, it is called Demand Pacemaker.
Atrial Synchronous Pacemaker