CARDIAC

PACEMAKERS
PRESENTED BY:
RAMOS, SANDREX-GIO Q.
VENTURA, BENJAMIN III B.
MERCADO, JASHMYN ANNE S.
YOGYOG, LAINETTE D.
WHAT IS A PACEMAKER?
• a small device that's placed in the chest or abdomen to
help control abnormal heart rhythms.
• uses electrical pulses to prompt the heart to beat at a
normal rate.
• Pacemakers correct an abnormally slow heartbeat by
sending electrical impulses to one or more chambers of
the heart. These signals make the heart contract in a
more regular rhythm than the chamber would otherwise.
• Pacemakers are designed to treat cardiac conditions that
involve “bradycardia” (an abnormally slow heartbeat)
HEART CONDITIONS THAT MAY WARRANT
A PACEMAKER:
1. Sinus node dysfunction
2. Heart block
3. Carotid sinus hypersensitivity
4. Arrhythmias arising from ablation
HISTORY
• 1600 – William Harvey restarted an arrested pigeon’s
heart by a simple flick of the finger.
• 1775 – Nickolev Abildgaard conducted the first
studies on the effects of electrical energy when
applied to the body.
• 1872 - Duchenne de Boulogne, successfully
resuscitated a child who had drowned
• 1882 - golden opportunity for clinical and scientific
experimentation arose
• 1958 - Senning and Elmqvist
HISTORY
• 1960 – First atrial triggered pacemaker
• 1964 – First on demand pacemaker (DVI)
• 1977 – First atrial and ventricular demand pacing
(DDD)
• 1981 – Rate responsive pacing by QT interval,
respiration, and movement
• 1994 – Cardiac resynchronization pacing
PARTS OF THE PACEMAKER

houses the
battery and a
tiny computer

Wires that send impulses from the pulse

generator to the heart muscle, as well as
sense the heart’s electrical activity. Each
impulse causes the heart to contract.
1. Pulse Generator

Parts of the Pulse Generator:

  a. Battery: Lithium Iodide (5-8 years life span)
- Single chamber pacemaker: 7 to 12 years
- Dual chamber pacemaker: 6 to 10 years
• Most pacemakers generate 2.8V in the beginning
of life which becomes 2.1 to 2.4V towards end of
life.
b. Sensing circuit
c. Timing Circuit
d. Output Circuit
 GENERAL CHARACTERISTICS OF
PACEMAKER BATTERIES
 

• Hermeticity
• low rate of self-discharge
• a long shelf life and high energy density –
lithium iodide
2. Leads - carry the electrical impulses from
the generator.
POSITION WITH THE HEART
1. Endocardial – a lead that is passed through the
venous system and contacts the endocardium
(innermost layer of the heart) of the heart.
2. Epicardial – leads that are placed directly on the
epicardium. (Outermost layer of the heart)
a. Screw-in
b. Screw-out
FIXATION MECHANISM
1. Active Fixation - the lead is kept in contact
with a metal screw-in fixation
2. Passive fixation – the lead is kept in contact
with rubber fins or tines
POLARITY OF LEADS
1. Unipolar - leads that are the thinnest and
have the highest reliability.
2. Bipolar - have 2 electrodes and offer
improved rejection of cross talk but usually
larger and not as reliable.
3. Multipolar - special purpose leads
INSULATION OF LEADS / INSULATOR
1. Silicone: have better long term reliability,
but are thicker and stickier and more difficult
to implant.
2. Polyurethane: are the thinnest, they slide
the best, easiest to implant.
3. ELECTRODES
• At the tip of each lead is a tiny device called an electrode
that delivers the necessary electrical impulses to the
heart. Thus, the electric impulses are created by the
generator, carried by the leads and delivered by the
electrodes to the heart.
a. Steroid-eluting - elute a small amount of steroid and tend to
have a lower pacing threshold that can prolong the PM life
b. Non-steroid eluting - less expensive and have higher pacing
thresholds but can provide adequate sensing thresholds.
PACEMAKER CASING
• The casing (or can) of the pacemaker is
made out of Titanium, a very light metal
that has two great qualities:
• Biocompatible
• Stronger than steel.
PACEMAKER TYPES
1. Single Chamber Lead is used when:
• The only problem is with the formation of the initial impulse
• The patient is in atrial fibrillation
• The problem with slow heart rate occurs only occasionally
and for brief periods of time.

2. Dual Chamber Lead

INSERTING A PACEMAKER
1. External or temporary. The pacemaker is
outside of the body, with wires connecting it to
the patient’s heart via a thin, hollow tube in the
patient’s body.
2. Internal or permanent pacemakers are used
when the slow heart rate becomes chronic or is
believed to be irreversible. The pacemaker is
implanted into the chest or abdomen, usually
on the left side of the chest.
MACHINE MECHANICS
• Current: 65-100 mA in unstable bradycardias
and 50-70 mA in stable patients.
• Electrodes: surface area of at least 5
cm2.Usually 80-100 cm2
DEVICES THAT MAY AFFECT
PACEMAKER FUNCTION
• Metal detectors
• Cellular phones
• Magnetic resonance imaging test (MRI).
• Strong electrical fields.
THANK YOU!