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Implantable Cardiac Pacemakers

The document provides an overview of implantable cardiac pacemakers, detailing their introduction, indications for use, and components such as pulse generators, leads, and programmers. It discusses the operation of modern pacing systems, clinical outcomes, cost implications, and lifestyle considerations for patients with pacemakers. Additionally, it highlights the importance of understanding the technology and potential health issues associated with pacemaker implantation.

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Bipin Thapa
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3 views16 pages

Implantable Cardiac Pacemakers

The document provides an overview of implantable cardiac pacemakers, detailing their introduction, indications for use, and components such as pulse generators, leads, and programmers. It discusses the operation of modern pacing systems, clinical outcomes, cost implications, and lifestyle considerations for patients with pacemakers. Additionally, it highlights the importance of understanding the technology and potential health issues associated with pacemaker implantation.

Uploaded by

Bipin Thapa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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BME 7503

Principles of Bioinstrumentation and


Devices

Implantable Cardiac

Pacemakers

Presented By
Major Bipin Thapa
Magar
Contents

Introduction

Indications

Components of Modern Pacing System


 Pulse Generators
 Leads
 Programmers

System Operation

Clinical Outcomes and Cost Implications


Introduction
 Artificial device to provide controlled electrical stimuli to the
heart
 Clinical practice since 1960 (250 gm)
 Significant improvement with technological evolution
 Size (25 gm)
 Multiprogrammability
 Diagnostic function
 Data collection
 Reliability
 Extended durability
 Approx. 350,000 patients worldwide
Indicators
 Decision to implant permanent pacemaker
 Symptom relief (at rest/ physical activity)
 Restoration of functional capacity
 Reduce mortality
 In 1984, guideline for pacemaker implantation by ACC/ AHA
 Categories of Pacing indications
 Heart block
 Sick sinus syndrome
 Myocardial infraction
 Hypersensitive carotid sinus syndrome
 ACC/ AHA provided conditions for classifying conditions
 Group I (pacing is considered necessary)
 Group II (pacing may be necessary)
 Group III (pacing is considered inappropriate)
Components of Modern Pacing System
 Three distinct components:
1. Pulse Generator
2. Lead
3. Programmer

Pulse Generator
 Two major functions; pacing (generates stimulus) and sensing electrical
activity
 Components:
1. Sensing circuit
2. Output circuit
3. Timing circuit
4. Power source
5. Telemetry circuit
 Housing; sealed titanium case with connectors
Pulse Generator
Sensing Circuit
 Recognition of appropriate signal

 Two different configurations; unipolar and bipolar

 Sensing element implemented by band pass filter (slew rate and sensitivity)

R wave: 10-30 Hz
T wave, far field signals: 5 Hz or lower
Skeletal muscle: 10-200 Hz
Central frequency of sensing filter: 30
Hz

P wave: 2-6 mV
R wave: 5-25 mV

Too flat or too steep may be eliminated by the bandpass filter


Pulse Generator
Output Circuit
 Generation of pacing pulse/ electrical stimuli

 Discharge of a capacitor charged by a battery

 Output energy controlled by two programmable parameters; pulse amplitude


and pulse duration
 Pulse amplitude: 0.8 – 5 V, Pulse duration: 0.05 – 1.5 ms

Timing Circuit
 Regulates timing parameters (pulse duration, pacing cycle length, specific
timing intervals)
 Crystal oscillators for clock generation
Pulse Generator
Telemetry Circuit
 Two way communication between pulse generator programmer (300 Hz)

 Provide info (pulse amp, duration, lead impedance, battery impedance, lead
current etc) to programmer
 deliver coded message to alter any of programmable features (noninvasive)

Power source
 Over years different batteries technologies were developed

 Desirable requirements
 Non toxic, non reactive
 Small size and longevity
 Lithium-iodide technology (2.8 V, 15 years)

Elective Replacement Indicator: 2.0-2.4 V


End of Life: 1.8 V
Leads

Electrode
 tip of lead, direct contact with heart muscle, porous tip
 impedance matching and battery longevity
 Platinum-iridium
Conductor
 carries electric signals to the pulse generator and delivers the pacing pulses to the
heart
 flexible and strong
 evolved from single straight wire to coiled to modern coaxial design
Insulator: electrical isolation to conductor, silicone & polyurethane
Terminal pin: generator-lead connection
Implantation of leads: Epicardial/ Endocardial
Programmers

 Non invasive reversible alteration of functional parameters


 Adjust the patient changing needs
 Tool for changing setting, retrieving diagnostic data & conducting non
invasive tests
System Operation
 Pacemakers have become more powerful at the cost of greater complexity
over time, use of various sensors (activity sensor, stroke volume, blood, pH, O2)
 Manufacturers responded with variety of interpretative aids

The Marker Channel


Diagram for interpretation
of the ECG strip faster
System Operation
 North American Society of Pacing and Electrophysiology and the British
Pacing and Electrophysiology Group developed 5 letter code for easy
understanding of modern pacemakers

a DDDR device is one that is programmed to pace and sense in both chambers
and is capable of sensor-driven rate variability
Clinical Outcomes & Cost Implication

 Effective in patients with sinus node dysfunction (reduce life-threatening


complications like congestive heart failure and stroke) [Andersen et al., 1993]
 Dual-chamber pacing significantly cheaper than single-chamber pacing over
the full course of therapy
Lifestyle issues
 Although home and office equipment do not have significant interference
with pacemaker some of the activities should be given special consideration.
Patients with pacemakers should restrict activities such as full-contact sports
 Activity that involves intense electro-magnetic fields should be avoided (arc
welding, maintaining heavy equipment that generates intense magnetic field)
 A number of medical devices and procedures may have significant effect so it
should be notified to medical personnel before any medical procedures
Possible Questions
1. What is implantable cardiac pacemaker? Discuss about the
basic features of an implantable cardiac pacemaker.

2. What are the major components of modern pacing system?


Describe them.

3. What are the health issues arisen after getting a pacemaker?


What type of caution should be considered by the patient in
his/her daily life?

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