Cardiac

Implantable
Pacemakers

Rocio Rodriguez
Advanced Engineering Materials
Dr. Haider
 Table of Contents
I. What is a I. Pulse Generator
Pacemaker? II. Lead Wires and
II. Heart Electrodes
III. History III. Lead and Pocket
IV. Modern Pacemakers Complications
V. Power Supply IV. The Future
V. References
 What is a Pacemaker?
A medical device that uses
electrodes that are use to sense
and then sends signals to the
heart to help regulate the
beating.
Used on patients whose hearts
natural pacemakers (sinoatrial
node) isnt functioning correctly.
This irregularity causes abnormal
beatings which could be deadly
if untreated.

Three types:
1. Single chamber pacemakers wires
are threading into a single chamber Figure 1: Modern Dual Chamber
of the heart.
Pacemakers.
2. Dual chamber pacemakers two
sets of wires are threaded into the
heart, one in each chamber.
3. Rate responsive pacemaker
contains activity sensors that
responds to the patients activity
level.

"What Is a Pacemaker?" - NHLBI, NIH. N.p., n.d. Web. 11 Nov. 2014.

 Figure 2: Schematic picture demonstrating an implanted pacemakers.

http://www.protein-structure.net/reading-103-The-Insertion-Procedure-and-Aftercare-of-Pacemaker.html
 The Heart
Four chambers
Right atrium receives the
deoxygenated blood from the
body.
Right ventricle sends
deoxygenated blood to the lungs
through the pulmonary valve.
Left atrium receives oxygenated
blood from the lungs.
Left ventricle contracts to send
the oxygenated blood through
the aortic valve to the rest of the
body. Figure 3: Heart diagram.
Electrical system
Sinoatrial node sends electrical
signals to contract the atriums
Atrioventricular node receives
signals from sinoatrial node then
sends electrical signals to the
Purkinje fibers to contract the
ventricles.

"Pacemakers." Texas Heart Institute Heart Information Center. Texas Heart Institute, n.d. Web. 09 Nov. 2014.
 The History

Biomedical Instrumentation & Technology, Jul/Aug2007, Vol. 41 Issue 4, p301-304

 Hyman External Pacemaker
o In 1932, Albert Hyman, created
an electro-mechanical
instruments that was powered
by a hand-cranked motor.
(external)
o Powered by on external AC .
o Used vacuum tubes.

Figure 5:

Figure 4: Hymans first pacemaker. A

hand-cranked motor that supplied
electrical shocks to a patient.

"History of Pacemakers." History of Pacemakers. Biotele, n.d. Web. 13 Nov. 2014.

 Greatbatch
o In 1962, Wilson
Greatbatch
invented the first
implanted
pacemaker.
o Materials
o Lead
o Mercury batteries
o Titanium Figure 6: Greatbatchs original
o 6 cm by 1.5 cm implantable pacemaker design.
Model and circuit system.

W. Greatbatch, Medical cardiac pacemaker, US Patent 3,057,356, October 1962.

Through the years
After the first implanted pacemaker was a success, new
developments started to occur.
The power supply
Sensing cardiac signals.
No need to recharge.
The surgery
Endocardial electrodes through the veins to the heart.
The materials
Longer lasting
Lighter
Faster
Dependable

and much more that have helped shape the pacemakers

today.
 Modern Pacemakers
Power Pulse Pacing Leads
Supply Generator and Electrodes

Casing
-Housing for battery and circuit.
Made out of Titanium
High modulus elasticity
High resistance to corrosion
High durability Figure 7: Pacemaker titanium casing.
Strong This is known as the housing.
Not degraded
Biocompatible

"Materials - Biomaterial : Cardiac Pacemaker." Biomaterial : Cardiac Pacemaker. N.p., n.d. Web. 13 Nov. 2014.
 Power Supply
Lithium/iodine battery.
Life span of 10 and plus years.
Once life is near to end, the
voltage decreases.
A pacemaker has an indicator
that signals doctors that its time
for a new battery.

Before, Zinc Mercury batteries Figure 8: Greatbatchs pacemaker

were used. Lasted roughly with Zinc Mercury batteries.
around 1 to 3 years.
Pacemakers were being
replaced too often.

Scrosati, Bruno. "History of Lithium Batteries." Journal of Solid State Electrochemistry 15.7-8 (2011): 1623-630. Web. 9 Nov. 2014.
 Lithium/iodine Battery Li-I2
Created/researched in 1970s.
Lithium company was founded by
Wilson Greatbatch.
Due to its electrochemical
equivalent, the highest among all
metals, lithium can in fact assure
theoretical specific capacity
much higher than zinc.
At 37C and can provide10 50
microamps of current, and it will
do it reliably for many years.

Important Battery Properties

Capacity (Ampere hours)
Energy (Watt hours)
Power (Watts)

Figure 9: Graph showing the comparison between

batteries according to their voltage and capacity
discharge.

Scrosati, Bruno. "History of Lithium Batteries." Journal of Solid State Electrochemistry 15.7-8 (2011): 1623-630. Web. 9 Nov. 2014.
 Case Study Lithium Batteries
o Conventional batteries:
alkaline-manganese, nickel-
cadmium, or lead-acid no
longer coped with the
innovating events.
o Their lack of energy
density offered only a
limited value of
capacity.
o Too heavy and big.

o Lithium assured higher energy

to weight & volume.
o Lithiumiodine battery,
Fig. 10: Energy density versus specific density
provided a practical energy diagram for various types of batteries
density of about 250 Wh/kg
o Close to five times higher
than that of the zincmercury
oxide.

Scrosati, Bruno. "History of Lithium Batteries." Journal of Solid State Electrochemistry 15.7-8 (2011): 1623-630. Web. 9 Nov. 2014.
 Case study continued
o Lithium Iodine was compared
to the traditional battery source
(Zinc Mercury).
o Problem with Zinc Mercury
batteries was that the life span
was too short.
o Surgeries were frequently
happening.
o Costs were relatively high.
o After lithium was chosen
because of its great properties,
it was tested against Zinc
Mercury.
o Results: Operational life of Fig. 11: Durability of comparison between
Lithium Iodine extended to zinc mercury and lithium iodine batteries.
about 6 to 7 years, much longer
than that of Zinc Mercury.

Scrosati, Bruno. "History of Lithium Batteries." Journal of Solid State Electrochemistry 15.7-8 (2011): 1623-630. Web. 9 Nov. 2014.
 Pulse generator
Tracks intrinsic atrial activity or
every response input from a
sensor.
Supplies impulses to the implanted
electrodes, either at a fixed rate
or in a programmed pattern.
Converts electrical energy to
electrical signals.
Control timing of delivery of
signals.
Contains differential amplifier,
filter, level shifter and
synchronizing circuit.
Materials used: Fig. 12: A traditional pacemakers pulse
generator.
Lithium-carbone
Lithium-Iodine
Mercury

"Materials - Biomaterial : Cardiac Pacemaker." Biomaterial : Cardiac Pacemaker. N.p., n.d. Web. 13 Nov. 2014.
 Pacing Leads 2. Connector Pin
o Inserted in connector block.
o Polytetramethylene
1. Lead body o Connects the lead body to
o Soft the pacemaker.
o Malleable
o Corrosion
Resistant
o Insulated with Fig. 14: Connector pin.
silicone/polyuret
hane
o Capability to
withstand flexing Fig. 13: The lead
by cardiac body.
contraction. 3. Passive Fixation
o Carries the o Holds tip of
charge to lead in heart.
pacemaker and o Nickel
back to the cobalt alloy
heart. 3. Active Fixation Fig. 15: Passive
o Helix extends activation, holds
into tissue. on to the heart
o Allows for tissue.
Fig. 16: Active fixation,
screwed into the heart. lead
positioning.

"Materials - Biomaterial : Cardiac Pacemaker." Biomaterial : Cardiac Pacemaker. N.p., n.d. Web. 13 Nov. 2014.
 Lead and Pocket
Complications
Due to contractions of heart,
some complications occur with
movement of lead wires and
electrodes. Fig. 17: X-Ray of one of
Lead wires breaking. the lead wires broken.
Placement of electrodes
(fixation) affects the electrical
shocks which will in turn cause
problems with the irregular heart
beats.
Twiddler syndrome pacemaker
twists and causes lead
dislocation.
Pacemakers can result in
moving.
Frequency of complications:
10% - 30%
Fig. 18: Bar graph demonstrating the
types of complications.
Johansen, J. B., O. D. Jorgensen, M. Moller, P. Arnsbo, P. T. Mortensen, and J. C. Nielsen. "Infection after Pacemaker Implantation: Infection
Rates and Risk Factors Associated with Infection i." European Heart Journal 32.8 (2011): 991-98. Web. 13 Nov. 2014.
 Infection After Pacemaker
Implantation
Infections
Skin inflammation of placement
of pacemaker.
Lead wires breaking/moving.
Bacteria within hearts lining or
valves. (fatal)
Lung becoming punctured
because of air leak.
(pneumothorax)
Study group: Patients with
infection from Jan. 1982 Dec
2007
56,657 patients happened to
have infections within the years
studied.
26,522 deaths occurred.
596 pacemakers were removed
due to infections, others were
treated with antibiotics. Fig. 19: Graph comparing the percent survival
77.3% (461)- infection without infection and time since pacemaker
12. 9% (77)- mechanical implant.
protrusion
7.4% (44) erosion
2.3% (14) wound pain

Johansen, J. B., O. D. Jorgensen, M. Moller, P. Arnsbo, P. T. Mortensen, and J. C. Nielsen. "Infection after Pacemaker Implantation: Infection
Rates and Risk Factors Associated with Infection i." European Heart Journal 32.8 (2011): 991-98. Web. 13 Nov. 2014.
 Pocket Related
Complications
Pocket hematoma large Fig. 20: Pocket
hematoma.
and tense swelling.
Happen within 24 to 48
hours of surgery.
Skin erosion loss of some
epidermis. Can take
months to years occur. Fig. 21: Skin erosion.

Skin infection reaction to

pacemaker. Due to
allergic reaction, can
take up to several weeks
to months to identify.

Gul, Enes E., and Mehmet Kayrak. "Common Pacemaker Problems: Lead and Pocket Fig. 22: Skin infection
Complications." Modern Pacemakers - Present and Future (n.d.): 299-318. Web. 13 Nov. 2014.
 Extraction of Pacemaker Lead
When infection becomes severe,
removing the whole pacemaker is
best.
Removing the pulse generator is
rather easy.
Removing the lead wires is done by
pulling force until they slowly break
and detach from wall of the heart.
Small chance of tearing
surrounding blood vessel or making
a hole on the heart.
Blood clot
Stroke
Swelling of the arm Fig. 23: Lead wires with scar
Bleeding under skin tissue on the tip.
Fluid accumulation around
heart/lung
From 1995 2008, 57 deaths were
reported due to complications
while extracting the pacemaker
lead.

Buch, Eric, Noel G. Boyle, and Peter H. Belott. "Pacemaker and Defibrillator Lead Extraction." Pacemaker and
Defibrillator Lead Extraction. American Heart Association, 2011. Web. 13 Nov. 2014
 The Future
In 2013, leadless and
smaller pacemakers
have been making a
breakthrough.
However, its too soon
to see the long term
advantages and Fig. 24: Schematic
picture of implanted
disadvantages. leadless pacemaker.
Created by St. Jude
Medical.
24 millimeters long
and volume is less
than a cubic
centimeter.
Nanostim
Pacemaker
Fig. 25: Comparison of traditional
pacemakers to new leadless pacemaker.

"Pacemakers of the Future: No Batteries Required? - Futurity." Futurity. N.p., n.d. Web. 11 Nov. 2014.
 Leadless Pacemakers
Listens to electrical activity of the
heart using its ultralow-power
electronics.
Placed in the right ventricle of the
heart.
The device is delivered to the heart
via a catheter through the femoral
vein. Fig. 26: Leadless pacemaker
being compared to a coin.
Less infection risk.
Completely Invisible.
Battery life same as usual
pacemaker, 9 years or longer since it
uses rate responsive programming. St. Jude Medical study
700 participants
Traditional pacemakers had battery Study Start Date:
in titanium can. December 2013
Leadless Pacemaker has the titanium Estimated Primary
can as a battery. Completion Date: June
2015
Estimated Study
http://www.youtube.com/watch?fea Completion: March 2020
ture=player_embedded&v=uJRdQUT
Hs_Y

"The Nanostim Leadless Pacemaker." St. Jude Medical. St. Jude Medical, n.d. Web. 13 Nov. 2014.
References
Buch, Eric, Noel G. Boyle, and Peter H. Belott. "Pacemaker and Defibrillator Lead
Extraction." Pacemaker and Defibrillator Lead Extraction. American Heart
Association, 2011. Web. 13 Nov. 2014.
Gul, Enes E., and Mehmet Kayrak. "Common Pacemaker Problems: Lead and
Pocket Complications." Modern Pacemakers - Present and Future (n.d.): 299-318.
Web. 13 Nov. 2014.
Haddad, Sandro, Richard Houben, and Wouter A. Serdin. "The Evolution of
Pacemakers." EEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE (2006): 38-
48. Web.
"History of Pacemakers." History of Pacemakers. Biotele, n.d. Web. 13 Nov. 2014.
Johansen, J. B., O. D. Jorgensen, M. Moller, P. Arnsbo, P. T. Mortensen, and J. C.
Nielsen. "Infection after Pacemaker Implantation: Infection Rates and Risk Factors
Associated with Infection in a Population-based Cohort Study of 46299 Consecutive
Patients." European Heart Journal 32.8 (2011): 991-98. Web. 13 Nov. 2014.
"Materials - Biomaterial : Cardiac Pacemaker." Biomaterial : Cardiac Pacemaker.
N.p., n.d. Web. 13 Nov. 2014.
"The Nanostim Leadless Pacemaker." St. Jude Medical. St. Jude Medical, n.d. Web.
13 Nov. 2014.
"Pacemakers." Texas Heart Institute Heart Information Center. Texas Heart Institute,
n.d. Web. 09 Nov. 2014.
Scrosati, Bruno. "History of Lithium Batteries." Journal of Solid State Electrochemistry
15.7-8 (2011): 1623-630. Web. 9 Nov. 2014.
"What Is a Pacemaker?" - NHLBI, NIH. N.p., n.d. Web. 11 Nov. 2014.