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Medical Instrumentation II - Defib and Pacemaker

Pacemakers use electrical pulses delivered via electrodes to contract the heart muscles and regulate heartbeat, either to increase a slow natural pace or conduct electrical signals in cases of blockage. Modern pacemakers are programmable and can stimulate different positions in the heart to improve synchronization. The main components of a pacemaker are a metal case, electronic circuitry, battery, sensor, and leads to conduct pulses to the heart.

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Rula Bastoni
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66 views14 pages

Medical Instrumentation II - Defib and Pacemaker

Pacemakers use electrical pulses delivered via electrodes to contract the heart muscles and regulate heartbeat, either to increase a slow natural pace or conduct electrical signals in cases of blockage. Modern pacemakers are programmable and can stimulate different positions in the heart to improve synchronization. The main components of a pacemaker are a metal case, electronic circuitry, battery, sensor, and leads to conduct pulses to the heart.

Uploaded by

Rula Bastoni
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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BM552

Medical Instrumentation II

Prerequisite: BM551 Medical Instrumentation I

Second semester 2022-2023

Sameer Hasan, PhD, BME


Defibrillator
Defibrillator

• The heart is able to pump blood effectively only when contractions of all its muscle
fibres are precisely synchronized. In Ventricular Fibrillation (VF), the normal rhythmic
ventricular contractions are replaced by rapid, irregular twitching that results in
ineffective and severely reduced pumping. If normal rhythm is not restored quickly,
death is imminent.

• Getting the heart out of this situation is called defibrillation. This can often be achieved
by applying an electric shock to the heart to depolarize the myocardium and stop the
uncoordinated contractions.
• The SA node can then resume normal function, and sinus rhythm can be restored.

An ECG monitor included with the unit is used to


verify a shockable rhythm and the effectiveness of
treatment.
Defibrillator

Defibrillators typically have three basic modes of operation:


• external defibrillation,
• internal defibrillation,
• synchronized cardioversion

The electrical energy discharged to the patient in each mode is provided by a large
capacitor that is charged over a period of several seconds by rechargeable
batteries or by line power.
An audible and/or visible indicator on the defibrillator informs the operator when
the capacitor is charged, and the device is ready for discharge.
External Defibrillation

For external defibrillation, the operator typically applies the paddles


firmly to the patient’s chest and discharges the defibrillator by
simultaneously pressing two discharge buttons (one button on each
paddle).
The electrical discharge, which lasts less than 20 milliseconds, delivers a
high-voltage shock of approximately 2,000 to 4,000 Volts to the patient.
Gels, pastes, or disposable defibrillation pads are used to improve
conductivity between the paddles and the chest. The paddle handles are
well insulated to protect the operator from shock.

Disposable defibrillation electrodes, which stick to the Paddle types used for external defibrillation include
patient’s skin and connect to the defibrillator through a standard adult (13 cm) and pediatric handheld
reusable cable, can be used as an alternative to paddles. paddles which have typically 4.5 cm diameter
Internal Defibrillation

• For internal defibrillation in which the energy is delivered


directly to the exposed heart (e.g., during open-heart
surgery), all defibrillators are designed to limit the
maximum output energy to 50 Joules (J) to prevent injury
to the heart muscle.

• The paddles used for this purpose are smaller (about 50


mm in diameter), slightly concave, and designed to
withstand normal hospital sterilization.
Synchronized Cardioversion

• Synchronized cardioversion (sync mode) uses a defibrillator discharge to correct certain


arrhythmias, such as VT.

• After verifying that the sync marker pulse (which indicates where on the ECG waveform the
defibrillator will discharge) appears reliably on the R wave, the operator presses and holds
the paddle discharge buttons; a shock is delivered only when the control circuits sense the
next R wave.

• The delivery of energy is synchronized with and shortly follows the peak of the R wave,
preventing discharge during the vulnerable period of ventricular repolarization, which is
represented by the T wave; defibrillation during cardiac repolarization (T-wave) could
cause the heart to fibrillate.
Operating Principle

• The most important component of a defibrillator is a


capacitor that stores a large amount of energy in the
form of electrical charge, then releases it over a
short period of time.

• When the switch is in position 1, the capacitor is


charged. In position 2, the charge is released via
the paddles to the patient body. The inductor is
needed to prolong the duration of current flow.

• Successful defibrillation depends on delivery of the electrical charge to the myocardium.


Only part of the total current delivered (about 35 A) flows through the heart. The rest is
dissipated through the resistance of the skin and the rest of the body. The impedance of skin
and thoracic wall act as resistances in series, and the impedance of other intrathoracic
structures act as resistances in parallel with the myocardium. The total impedance is about
50–150 Ohms.
System Diagram
Pacemaker
Pacemaker
Siva K. Mulpuru, Malini Madhavan, Christopher J. McLeod, Yong-Mei Cha, Paul A. Friedman, Cardiac Pacemakers: Function, Troubleshooting, and
Management: Part 1 of a 2-Part Series, Journal of the American College of Cardiology, Volume 69, Issue 2, 2017, Pages 189-210,
Pacemaker

• A pacemaker (or artificial pacemaker, so as not to be confused with the heart's


natural pacemaker) is a medical device which uses electrical impulses, delivered by
electrodes contracting the heart muscles, to regulate the beating of the heart.

• The primary purpose of a pacemaker is to maintain an adequate heart rate, either


because the heart's natural pacemaker is not fast enough, or because there is a
block in the heart's electrical conduction system.

• Modern pacemakers are externally programmable and


allow a cardiologist to select the optimum pacing modes
for individual patients. Some combine a pacemaker and
defibrillator in a single implantable device. Others have
multiple electrodes stimulating differing positions within
the heart to improve synchronisation of the ventricles of
the heart.
Pacemaker

A pacemaker after the removal of its titanium housing


(front and back). The battery occupies 60% of its size. The
electronic circuits are assembled in multilayer. The
complete device weights 26 grams

• A pacemaker consists of the following components:


1. the metal encasement of the electronic circuit,
2. the electronic circuitry (including an ultra low power microcontroller)
3. the battery
4. a sensor to sense patient activity
5. one or more leads to conduct electrical impulses to the heart muscle.

• A connector block, made of polyurethane, is located at the top of the pacemaker. It


serves to attach the pacemaker to the pacemaker lead. The pulse generator is
encased in titanium. Titanium helps to shield the internal components and reduces
external electromagnetic interference (safety).
Pacemaker- System Diagram

• Diagram of a modern pacemaker. It


uses the input from electrodes/leads
to measure the activity of the heart
and adapt the pacemaker rate to this.

• A voltage pulse of 5 to 7.5 Volts is


delivered to the heart through the
pacing electrodes. The amplitude and
pulse width must be customized for
each patient.
• The Supply Voltage Supervisor (SVS)
monitors the battery voltage.

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