Medical Therapeutic and Support

Systems

EQUP5335

Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATORs & Cardioverters

2 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATORS & CARDIOVERTERS
 Defibrillator is a device that sends electrical energy, or shock, to the heart.

 The aim of using a defibrillator is to treat cardiac arrest.

 The need for this generally arises when the patient has ventricular
fibrillation or ventricular tachycardia, which are life-threatening arrhythmias
that occur when contraction of the ventricles become abnormal.

 Defibrillators have electrocardiogram (ECG) leads and adhesive patches

(or paddles). The adhesive electrodes are the patches placed on the patient’s
chest that deliver the electric shock
 Cardioverters Combination of cardiac monitor and defibrillator
3 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR THEORY OF OPERATION
 Defibrillators are electrotherapeutic high-voltage devices which are used within
course of resuscitation and to terminate tachycardic ventricular and supraventricular
arrhythmias

 Defibrillation is defined as applying brief, phasic pulse of energy intended to cause

simultaneous depolarization of all myocardial fibers

 After approximately 5 s of administering electrical pulse, no ventricular fibrillation or

ventricular tachycardia are detected any longer in ECG

 Objective: to terminate tachycardic ventricular and supraventricular arrhythmias so

that following refractory period which generally lasts 200-500 ms, SA-node once more
resume primary pacemaker function
4 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR THEORY OF OPERATION

5 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATORS & CARDIOVERTERS

6 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS

 treatment of ventricular fibrillation is called defibrillation,

Zero cardiac output - brain damage and death within 5 min
 treatment of the other tachycardias is called cardioversion.
 In cases of MI, there is often fibrillation, an extremely rapid, ineffective
beating of the heart. MI may also result in heart block, an interruption in
the electrical conduction system of the heart
 Cardioversion is the general term for restoration of a normal heart rhythm,
either by drugs or application of electric current.
(organized rhythms of atrial flutter and ventricular tachycardia)

7 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
HEART ABNORMITIES

The main deviations from normal that

can be found through an ECG are
(1) abnormalities in rate,
(2) abnormalities in rhythm, and
(3) cardiac myopathies

Representative heart conditions detectable through electrocardiography

8 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR TYPES
 Divided into manual, semiautomated, and fully automated external defibrillators, in addition to defibrillator
implants
 Semiautomated: user is shown defibrillation recommendation but administration of pulse is triggered by user

 Fully automated: everything is done by device

9 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CARDIOVERSION
 Synchronized defibrillation is referred to as cardioversion
 Pulse of energy is triggered by R wave in the ECG

 Synchronization is carried out to prevent pulse being delivered in vulnerable phase (T

wave) and to prevent risk of ventricular fibrillation being triggered
 Different possible methods of application

10 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS

There are different kinds of defibrillators in use today. They include the

 Manual external defibrillator,

 Manual internal defibrillator,

 Automated external defibrillator (AED),

 Implantable cardioverter-defibrillator (ICD),

 and Wearable cardiac defibrillator.

11 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS
•Manual external defibrillator:
- These defibrillators require more experience and training to effectively
handle them.
- they are only common in hospitals and a few ambulances where capable
hands are present.
- In conjunction with an ECG, the trained provider determines the cardiac
rhythm and then manually determines the voltage and timing of the shock—
through external paddles—to the patient’s chest.

12 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS
•Manual internal defibrillator:
- The manual internal defibrillators use internal paddles to send the electric
shock directly to the heart. They are used on open chests, so they are only
common in the operating room. It was invented after 1959

13 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS

14 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS
Automated external defibrillator (AED):
These are defibrillators that use computer technology, thereby making it easy
to analyze the heart’s rhythm and effectively determine if the rhythm is
shockable.
They can be found in medical facilities, government offices, airports, hotels,
sports stadiums, and schools.

15 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS
•Implantable cardioverter-defibrillator:
- Another name for this is automatic internal cardiac
defibrillator (AICD).
- They constantly monitor the patient’s heart, similar to a
pacemaker,
- can detect ventricular fibrillation, ventricular
tachycardia, supraventricular tachycardia, and atrial
fibrillation.
- When an abnormal rhythm is detected, the device
automatically determines the voltage of the shock to
restore cardiac function.
- provide Pulses from 5-30 J
16 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
TYPES OF DEFIBRILLATORS
•Wearable cardiac defibrillator:
Further research was done on the AICD to bring forth the wearable cardiac
defibrillator,
- which is a portable external defibrillator generally indicated for patients
who are not in an immediate need for an AICD.
- This device is capable of monitoring the patient 24-hours-a-day.
- It is only functional when it is worn and sends a shock to the heart
whenever it is needed.
However, it is scarce in the market today.

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
BASIC DEFIBRILLATOR TYPES(Waveforms)

 AC defibrillator

 capacitive-Discharge DC Defibrillators
-
1- lown
2- monopulse
3- tapered (dc) delay
4- trapezoidal wave.

 square-wavedefibrillator

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
AC DEFIBRILLATOR
• Before 1960 were AC model
• This First defibrillators machine used several
hundred volts applied 5 to 6 A of 60 Hz across
the patient’s chest for 250 to 1000 ms.
• The success rate for AC defibrillator was rather
low
• Since 1960, several different dc defibrillators
have been devised.
• This machines store a dc charge that can be
delivered to the patient.
• The different between dc types in the wave shape
of the charge delivered to the patient
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
ADVANTAGES OF DC VS. AC

fewer deleterious effects on the heart

less likely to produce ventricular fibrillation With random application

during the cardiac cycle

diminish convulsive effect on skeletal muscles

applicable to atrial arrhythmias

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN

- The current will rise very rapidly to about 20 A under the influence of slightly less than
- 3 kV .
- The waveform then decays back to zero within 5 ms and then produces a smaller
negative pulse also about 5 ms.
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN WAVE FORM DEFIBRILLATOR

• That is, the capacitor stores energy, WA,

which develops a voltage, V, across its
metal plates.
The amount of energy in units of joules
is given by V2
WA  C
2

• where C is the value of the capacitance

measured in units of farads and V is the
This particular waveform called ‘ Lown’ waveform Inductor used to create a finite
voltage across the capacitor. damped sine wave from DC
• Ranges from 50 to 400 joules. .
 Pulse range: 3-8 ms at current of 10–27A (internal) and 22–60A (external)
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM

- Monopulse is a modified lown waveform and commonly found in certain

portable defibrillator.
- It is created by the same circuit of lown but without inductor L.

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM

- Tapered delay wave form , a lower amplitude 1.2 kV and longer duration 15 ms
to a chive the energy level
- It is created by placing two L–C sections

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM

- Trapeziodal low voltage / long duration ( 800 V : 500 V & 20 ms

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
There are two general classes of waveforms:
a)mono-phasic waveform
• Energy delivered in one direction through the patient’s heart

b)Biphasic waveform
• Energy delivered in both direction through the patient’s heart

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
Biphasic waveforms are preferably used
 More effective on first shock and gentler on heart with less dysfunction

 Differ with varied adaptation to thoracic impedance of patient (e.g., peak-to-peak voltage
and pulse duration)
 Defibrillation success achieved with lower energy and voltage

 Device-dependent amount of energy is 150–200 J for first defibrillation and 200–360 J for
all others, whereas it is always 360 J with monophasic wave
 Biphasic pulse forms allow devices to be further miniaturized

 Whereas optimum energy flow in monophasic defibrillation is in range 30-40 A, with

biphasic shock it is in range 15-20 A
 Operating modes: synchronous and asynchronous operation

 Synchronous: heart’s own pulses are taken into account (QRS triggering)

 Asynchronous: reserved for strictly emergency defibrillations

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM

The biphasic waveform is preferred over monophasic waveform to defibrillate

•A monophasic type, give a high-energy shock, up to 360 to 400 joules due

to which increased cardiac injury and in burns the chest around the shock
pad sites.

• A biphasic type, give two sequential lower-energy shocks of 120 - 200

joules, with each shock moving in an opposite polarity between the pads.

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
CLASSES OF DISCHARGE WAVEFORM
• Differences between monophasic and biphasic systems
In monophasic systems, the current travels only in one direction - from one
paddle to the other.
• In biphasic systems, the current travels towards the positive paddle and
then reverses and goes back; this occurs several times .

• Biphasic shocks deliver one cycle every 10 milliseconds and they are
associated with fewer burns and less myocardial damage.

• With monophasic shocks, the rate of first shock success in cardiac arrests
due to a shockable rhythm is only 60%, whereas with biphasic shocks, this
increases to 90%.
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
THE SQUARE AND TRAPEZOIDAL WAVEFORM DEFIBRILLATO

Figure 13.10 The square and trapezoidal waveform defibrillator may have a battery that drives the ac
charging supply. Diode D rectifies the ac to charge capacitor C. Series SCR1 is turned on to deliver
current to subject RL. The timing circuit calculates the charge delivered, then after duration d, shunt
SCR2 short circuits the charge. (From L. A. Geddes, Cardiovascular Devices and their Applications, New
York: John Wiley & Sons, 1984.)

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
 CARDIOVERTER
Special defibrillator constructed to have synchronizing circuitry so that the
output occurs immediately following an R wave
In patients with atrial arrhythmia, this prevents possible discharge during a
T wave, which could cause ventricular fibrillation
The design is a combination of a cardiac monitor and a defibrillator
Cardioscope
ECG Analog
ECG AMP
Electrodes Switch

Trigger AND 30ms Threshold

Filter
Circuit Gate Delay Detector

Defibrillation Operator-controlled
Electrodes Defibrillator Switch

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR TYPES

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR TYPES

Internal( Implantable ): (Manual or Automated-AED)

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
THORACIC IMPEDANCE
 Definition: resistance in body which opposes energy pulse from defibrillator

 Ranges between 15 and 150 Ω; usually it is 70–80 Ω

 Must be taken into consideration when necessary energy is administered, as

patient’s thoracic impedance is crucial to amount of energy required

 Because impedance varies to large degree in humans, dynamic adaptation of

energy pulse waveform is important feature

 Modern devices automatically measure thoracic impedance and take into

account before defibrillation to deliver energy more accurately
LOWN WAVE FORM DEFIBRILLATOR
• To
. calculate how much of this energy gets
to the patient, resistance RT, consider the
equivalent circuit.
The four resistors in this circuit are in
series.
The formula for the energy absorbed by
the thorax, WT is

RT
WT  WA
RD  2 RE  RT

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN WAVE FORM DEFIBRILLATOR

EXAMPLE
A defibrillator has an available energy, WA, of
200 joules (J).
If the thorax resistance is 40 ohms (W), the
electrode—skin resistance of a paddle with
sufficient electrode gel is 30 ohms and the
internal resistance of the defibrillator is 10
ohms.
Calculate the energy delivered to the
thorax of the patient.

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
LOWN WAVE FORM DEFIBRILLATOR

.
EXAMPLE
A defibrillator provides a 5 ms pulse of 20 A
to a 50  load.

Calculate the energy delivered to the thorax of

the patient.

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES
 Types of Defibrillator electrodes:-

a) Spoon shaped electrode

• Applied directly to the heart.

b) Paddle type electrode

• Applied against the chest wall

c) Pad type electrode

• Applied directly on chest wall

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES
Excellent contact with the body is essential
Serious burns can occur if proper contact is not maintained during
discharge
Sufficient insulation is required
Prevents discharge into the physician
Three types are used:

Internal – used for direct cardiac stimulation

External – used for transthoracic stimulation
Disposable – used externally

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES
 Types of Defibrillator electrodes:-

a) Spoon shaped electrode

• Applied directly to the heart.

b) Paddle type electrode

• Applied against the chest wall

c) Pad type electrode

• Applied directly on chest wall

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
DEFIBRILLATOR ELECTRODES

Electrodes

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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
PADDLES VERSUS ADHESIVE PATCHES
Paddles were originally used but their use is being superseded by adhesive
patches.
Adhesive patches are placed most commonly antero-apically - the anterior
patch goes under the right
clavicle and the apical patch is placed at the apex.
Adhesive electrodes are better, as they stick to the chest wall, so there is no
mess with gels.
Paddles require a significant level of force, which is not needed with adhesive
electrodes.
• Adhesive electrodes also allow good ECG trace without interference.
They are also safer, as no operator is required - although, before discharging a
shock, it is important to ensure everyone is clear of the patient
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Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
 Thank You
Any question ?!

44 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam