Biomedical Instruments-BME460

Chapter 7: Cardiac Defibrillators

R. S. Khandpur, 2nd Edition, Chapter 26
Dr. Qasem Qananwah

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 CHAPTER 7: Cardiac Defibrillator
CHAPTER OUTLINE
• Need for Defibrillator –arrhythmias

• Defibrillation Process
• Defibrillation strength and Duration

• Types of Defibrillators
External
Internal - Endocardial
Internal - Epicardial

• Defibrillation Electrodes
• Implantable Defibrillators
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 CHAPTER 7: Cardiac Defibrillator

Introduction

(a)
(b)

Figure : Pacemaker (a) Implantable Defibrillators, (b) External Defibrillator

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 CHAPTER 7: Cardiac Defibrillator
Need for Defibrillation

heart muscle fibres are

continuously stimulated by
adjacent cells

Source: [Link]

Figure : Restoration of normal rhythm in fibrillating heart as achieved by direct current shock (arrow) across the chest wall.

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 CHAPTER 7: Cardiac Defibrillator
Need for Defibrillation

[Link] [Link]
emergency-nursing/code-blue-defibrillation/

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 CHAPTER 7: Cardiac Defibrillator
Need for Defibrillation
• Used to treat ventricular fibrillation (cardiac arrest) loss of coordinated
contraction of muscle fibers in ventricles, death occurs in minutes if left
untreated.

• 500,000 cardiac arrest cases occur annually in US.

• 1,844 out of 12,223 death due to Ischemic heart disease in Jordan
(statistics 2004)
• Defibrillation involves the application of a strong electrical shock designed
to depolarize most of the heart cells simultaneously, which often
reestablishes coordinated contractions and a normal sinus rhythm.

• Exact physical mechanism leading to ventricular fibrillation is not known.

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 CHAPTER 7: Cardiac Defibrillator
Defibrillation Curve

Defibrillation Strength Duration Curve

• pulse amplitude in tens of amperes (few thousand volts).
• operator selects energy delivered: 50-400 joules, depends
on:
1. intrinsic characteristics of patient
2. patient’s disease
3. duration of arrhythmia
4. patient’s age
5. type of arrhythmia (more energy required for v. fib.)

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 CHAPTER 7: Cardiac Defibrillator
Defibrillation Process

Monophasic and biphasic waveform

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators

• For each minute elapsing between onset of ventricular fibrillation

and first defibrillation, survival decreases by 10%.
• Defibrillators should be portable, battery operated, small size.
• Energy in defibrillators usually stored in large capacitors.
• Total energy stored in capacitor:
1
WC  CVC2
2

Vc = capacitor voltage
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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators

Fig. 26.2: Schematic diagram of a defibrillator

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Capacitive Discharge Defibrillator
L Rlead

power
supply + Rchest
Vc C
_

Vchest C: (10 – 50)μF, takes about 10s to full charge

2kV Vc: (4,000 - 9,000) V for a maximal Energy of 400J
up to 40% of energy in C can be dissipated in L and Ri
response is slightly underdamped (depends on chest resistance R)

~10 ms t
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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Example: Rlead

power +
supply +
Vchest Rchest
Vc C
_
_

Rchest = 95Ω, Rlead = 5Ω, total energy stored in C is W = 300 J, want

to deliver 90% of W to heart in 8 ms. What value of C should be used?
RL  Rlead  Rchest
VC t   VC 0e  t / RL C , t  0
VC(0) = initial capacitor voltage after charging

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Example (Cont.):
Rchest
Vchest t   VC t 
Rchest  Rlead
Rchest
 VC 0e  t / RL C
 VC 0e  t / RL C  ……..(1)
Rchest  Rlead
Energy stored in capacitor at t = 0:
0 0

W   VC iC dt   VC  C
dVC 
 dt
 dt 
 
0
1
 C  VC dVC  CVC 0 2
….…..(2)

2
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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Example (Cont.):
energy delivered to Rchest:

Wchest  t   
tV2
chest  t  dt
0 Rchest

substituting (1):
Wchest t     2
tV2
C  
0 e  2t / R LC
dt
0 Rchest

using (2): 1 0.008 V 2  0e  2 t / R L C

0.9  CVC2 0   2  C
dt
2 0 Rchest

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Example (Cont.):
 2 ( 0.008) / R L C
 0.9 /   e 1
 2 ( 0.008) / R L C
0.0526  e
solving for C give: C = 54.3 μF

initial voltage across capacitor:

1
300J  CVC 0
2

2
Vc(0)=3,322.90V
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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators

Square Wave Defibrillators

Rlead
SCR2

power +
+ Load voltage regulated by
supply SCR1 thyristor (Silicon controlled
Vc Vchest Rchest
rectifier SCR).
C timing
_
circuit _

• during charging, SCR1 and SCR2 both open

• to defibrillate, SCR2 closes, current flows to chest Vchest
• after a fixed interval, SCR1 closes, shorts out C
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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
(a) Basic circuit diagram for a capacitive–discharge type of cardiac defibrillator. (b) A
typical waveform of the discharge pulse. The actual waveshape is strongly
dependent on the values of L, C, and the torso resistance RL.

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
• Defibrillation process assessment:
• HR
• PR, RR interval stability
• more sophisticated electrogram analysis.

Example:

A defibrillator provides a 5 ms pulse of 20 A to a

50  load.
Thus the energy delivered is
E = P = I2Rt =
(20A)2(50)(0.005s) = 100
J.
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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators

Automatic External Defibrillators (AEDs)

• Two modes of operation:

• Automatic: AED recognizes specific arrhythmias via
signal processing algorithms, applies shock as needed.
No manual control.
• Semi-automatic: operator must confirm shock advisory
from AED to deliver the shock.
• Less operator training needed

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators

Automatic External Defibrillators (AEDs)

LIFEPAK 500 Automatic

External Defibrillator
(AED) weighs 3 kg and is
portable (Medtronic inc.
2001).

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Defibrillator Electrodes
• Usually from metal, 70-100 cm2 surface area
• must be coupled to skin using conductive material (otherwise can
burn patient)
Two types of electrodes:
• Hand-held: conductive gel must be manually applied, reusable.
• Adhesive : adhesive conducting material holds electrode to
skin, disposable

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Hand-Held Defibrillators Electrodes
Electrodes used in cardiac defibrillation are in two shapes
(a) A spoon-shaped internal electrode that is applied directly to the
heart.
(b) A paddle-type electrode that is applied against the anterior chest
wall.

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Hand-Held Defibrillators Electrodes

Hand-held transthoracic electrode (From Tacker Jr. 1980).

Button

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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators

Adhesive Type Defibrillators Electrodes

Some examples of the pre-applied adhesive electrodes (From

Tyco/Healthcare Kendall  LTP 2001)
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 CHAPTER 7: Cardiac Defibrillator
External Defibrillators
Defibrillators Electrodes

Electrode Placement

anterior wall placement front-to-back placement

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 CHAPTER 7: Cardiac Defibrillator
CARDIOVERSION

• Cardioversion is also a shock supplied to treat other types of

arrhythmias such as:
• Atrial fibrillation
• Ventricular tachycardia (rapid heart rate)

• These types of arrhythmias are not life threatening but do

result in reduced cardiac output

• It is important that the cardioversion pulse not coincide with a

T-wave otherwise ventricular fibrillation may result.

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 CHAPTER 7: Cardiac Defibrillator
CARDIOVERSION
standby

power charge discharge

gate patient
supply

switch is under
operator control

energy timing ECG

storage circuitry monitor

applies shock about 20-30 ms

after QRS complex
Block diagram of Cardioversion
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 CHAPTER 7: Cardiac Defibrillator
CARDIOVERSION
DC Synchronized Defibrillators

In cardioverter, the
defibrillation pulse in
this case must be
synchronized with the R
wave of the ECG so that
it is applied to a patient
shortly after the
occurrence of the R
wave.

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 CHAPTER 7: Cardiac Defibrillator
Implantable Defibrillators

• Introduced for the first time by

Cardiac Pacemaker Inc (1985) in
USA
• Recommended for patients of high
risk for VF
• Usually combined with pacemaker

Implantable cardioverter defibrillator (ICD) (Medtronic inc., 2001).

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 CHAPTER 7: Cardiac Defibrillator
Implantable Defibrillators

• Treat v. fibrillation, tachycardia

• Usually incorporated as part of an implanted cardiac pacemaker
(typically VVI). Normally Biphasic wave is used
• Specifications:
• ~ 750V
• 30-35J
• Heart load ~ 50Ω
• Shock duration 4-8ms

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 CHAPTER 7: Cardiac Defibrillator
Implantable Defibrillators

Safety during defibrillation process:

• Operator should be careful not to touch

electrodes during defibrillation.
• Other personnel should remain clear of patient
and any metal objects contacting patient
during defibrillation.

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 The End…

Questions?????

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