SNS COLLEGE OF TECHNOLOGY
(AN AUTONOMOUS INSTITUTION)
Approved by AICTE & Affiliated to Anna University
Accredited by NBA & Accrediated by NAAC with ‘A+’ Grade,
Recognized by UGC saravanampatti (post), Coimbatore-641035.
Department of Biomedical Engineering
Vision Tit 2 Vision Title 3
Course Name: 19BMB301 Diagnostic & Therapeutic Equipment
III Year : V Semester
Unit I – Cardiology and Neurological Equipment
Topic : Pacemaker and its Types
19BMB203/DTE/Unit 1 /[Link] /AP/BME 1
Definition :
• Pacemaker is an electrical pulse generator for starting and/or
maintaining the normal heart beat
• Basically it contains two parts
• Pulse generator an electronic unit generates stimulating impulse of controlled
rate and amplitude
• Leads carries electrical impulses from pulse generator to the heart.
• The pulse repetition rate is usually 70 pulses/min, but many are
adjustable in the range of 50-150 pulses/ mins
• Duration : 1-3ms
Types based on mode of application:
• External pacemaker
• Internal pace maker
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External pacemaker Internal pacemaker
Pacemaker is placed outside of the
Pacemaker is miniaturized and is surgically
body. It may be in the form of wrist
implanted beneath the skin near chest
watch or in the pocket
Electrodes are endocardiac elctrodes Electrodes are myocardiac electrodes
It does not necessitate open chest
It requires an open chest minor surgery
surgery
battery can be easily replaced Battery can be replaced by minor surgery
During placement, swelling and pain
During placement, swelling and pain arises
do not arise due to minimum foreign
due to foreign body reaction 3
body reaction
External pacemaker
• External pacemaker to restart the normal rhythm of the heart in
cases of cardiac stand still ( short term pacing is adequate)
• The pacing impulse is applied through metal electrodes placed on the
surface of the body.
• Electrode jelly is used for better contact and to avoid burning of the
skin underneath
• An external pacemaker may apply upto 80 mA pulses through
electrode on the chest.
• Pulse delivered in two modes : continuously & on demand
• Continuously : when it is felt that heart rate is below the pre-set value,
pacemaker impulse given continuously.
• On demand (R synchronous pacing): pacemaker is inoperative but it is
activated when the heart rate falls below normal pre-set value 4
• Pacing with external pacemakers through chest requires a maximum of
150 V pulses across an impedance of the order 1 kohm
Disadvantage
• External electrodes tend to burn the skin and electric impulses becomes painful
• Pulses causes comfortable contraction of the thoracic muscles around the area of
electrodes.
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Implantable pacemakers
• Implantable pacemaker is placed beneath the skin. Output leads are
connected directly to the heart muscles.
• Basic req. for implantable circuit
• Components used in ckt should be highly reliable
• Power source should be in position to supply sufficient power to the circuit
for prolonged periods of time
• Circuit should be covered with biological inert material
• Unit should be covered in such a way that body fluids do not enter the circuit
and cause short circuit
• Avg life time of pacemakers
• 1968-1972 22 months
• 1974 31 months
• 1975 onwards more than five years
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Types of Implantable pacemakers
• Fixed rate pacemaker :
• Intended for permanent heart blocks
• The rate is preset, says 70bpm
• Fixed rate pacemaker performs regardless of the patient’s natural rhythm.
So it poses potential danger.
• Demand pacemaker:
• It function only when R-R intervals of natural rhythm exceed a pre-set limit
• Avoids competition between the hearts natural rhythm and pacemaker
rhythm
• R wave ( ventricular) triggered pacemaker:
• Mainly for patients who have sinus rhythm with occasional heart block
• It senses R- wave and fire harmlessly into the absolute refractory period
• When an R wave is not sensed (absent), the unit is preset to fire automatically
(asynchronous) 7
• Ventricular Inhibited or R wave Blocked Pacemaker
• Mainly for patients who have heart block with occasional sinus rhythm
• This device is suppressed by the occurrence of QRS complex and thus absence of
this complex, will pace the ventricle
• Atrial Triggered pacemaker
• Pacemaker senses the P wave ( atrial depolarisation) and triggers ventricular
contraction after suitable PR interval
• Advantage : providing maximum augmentation of cardiac output at changing
atrial rate to meet various physiological requirments
• Dual chamber pacemakers
• Mainly for patients suffer from SA node disease.
• Both atrial and ventricle activity are sensed and stimulated as needed while
maintaining proper synchronization with upper and lower chamber
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Ventricular synchronous Demand Pacemaker
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Block diagram description
• Pulse generator has two function : sensing and pacing
• Sensing is accomplished by picking up ECG signal
• It passes QRS band filter which pass the signal components in the
frequency range of 5-100Hz
• It is followed by amplifier and threshold detector ensures reliable detection
of cardiac signals with amplitude of 1-30mV
• Refractory period T1 is necessarily incorporated to limit the pulse delivery
rate (i.e) to prevent multiple retriggering of astable multivibrator
• Free running multivibrator provide fixed rate mode with T2 interval via
output driver circuit
• The output pulses of length T3 is delivered at the stimulating electrodes
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Power sources for implantable pacemakers
• Nickel Cadmium rechargeable cells
• Zinc - Mercury batteries
• Biological power sources ( galvanic cell with body fluid as electrolyte)
• Nuclear batteries ( plutonium 238 with half life of 87 years)
• Lithium cells ( lithium iodine battery – >10 years)
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