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Cardiac Pacemaker

A pacemaker regulates the heart rate through electrical stimulation when the natural pacemaker fails. It consists of a pulse generator and leads. The pulse generator produces stimulating pulses of controlled rate and amplitude. Leads carry the pulses from the generator to the heart. Pacemakers can be external, used temporarily, or implantable for long-term use. Implantable pacemakers are miniaturized and powered by batteries. They can be fixed-rate or demand pacemakers, which only stimulate when the heart rate falls below a preset level.

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151 views

Cardiac Pacemaker

A pacemaker regulates the heart rate through electrical stimulation when the natural pacemaker fails. It consists of a pulse generator and leads. The pulse generator produces stimulating pulses of controlled rate and amplitude. Leads carry the pulses from the generator to the heart. Pacemakers can be external, used temporarily, or implantable for long-term use. Implantable pacemakers are miniaturized and powered by batteries. They can be fixed-rate or demand pacemakers, which only stimulate when the heart rate falls below a preset level.

Uploaded by

Dhvij Kml
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Cardiac Pacemaker

• The rhythmic beating of the heart is due to the triggering of


Sino Atrial node (natural pacemaker) of heart.
• In abnormal situations if this natural pacemaker fails to
function or becomes unreliable or if the triggering pulse does
not reach the heart muscle because of blocking by the
damaged tissue (Heart block), the natural and normal
synchronization of the heart action gets disturbed.
• By giving external electrical stimulation impulses to the heart
muscle, it is possible to regulate the heart rate.
• An electronic instrument called pacemaker is used to give this
impulses.
• Pacemaker basically consists of 2 parts,
• 1)Pulse Generator-an electronic unit which generates
stimulating impulses of controlled rate and amplitude.
• The pulse generator consist of 2 parts
Impulse generating circuit-it is usually a multi-vibrator
circuit with adjustable rate and fixed pulse width
 It determines the frequency and duration of pulses.
Output circuit-the output circuit determines the shape
and amplitude of the pulses.
2)Lead- Which carries the electrical pulse from the generator to the
heart.
• The electrodes (Lead tip) are also used to record electrical activity
(Sensing)
• Most pacemakers use two leads; one in the right atrium & other in
the right ventricle. If necessary both leads can be used for pacing &
sensing.
Block diagram of pacemaker
• The electrode arrangement with the pacemaker can be of 2 types
• Bipolar-in this 2 electrodes are placed on the heart for
myocardial stimulation.
• Unipolar-one electrode is positioned on the heart and one
electrode is placed elsewhere on the body.
• There are 3 types of pacemakers based on the type of output waveform.
1)Voltage Pacemaker-in which the current in the circuit is determined by the
available voltage during the entire duration of impulse.
2)Current Pacemaker-through out the impulse the current in the circuit is
determined by the internal resistance of the pacemaker.
3)Current limited voltage pacemaker-this is primarily a voltage circuit, but the
maximum current in the circuit is limited preventing too large current flow.
Types of Pacemaker
• Depending on the mode of application of the stimulating pulse to the heart pacemakers
are classified as,
1)External Pacemaker- they are employed
• To restart a normal rhythm of heart
• In situation where short term pacing is adequate
• While the patient awaiting implantation of pacemaker
• Also for patients recovering from cardiac surgery.
The pacing impulse is applied through metal electrodes placed on the
surface of the body.
This procedure is painful and therefore only used in emergency situations.
The stimulating pulses can be preferably applied to the heart through a pacing
catheter passing a vein and connected to heart. This is called internal pacing.
The pulses may be delivered,
i)Continuously-when it is felt that the heart rate is below the pre-set
value. The impulse frequency is independent of the electrical activity
of heart.
ii)On Demand R-wave synchronous pacing- normally the pacemaker is
inoperative but it is activated when the heart rate falls below the
normal or pre-set value.
 This technique eliminates any competition between the heart’s own
pacemaker and externally applied pacemaker pulses.
They has the disadvantage that the electrodes eventually tend to
burn the skin and the electrical pulses become painful.
Implantable Pacemaker
The implantable pacemaker along with its electrodes, is designed to
be entirely implanted beneath the skin.
Its output leads are connected directly to the heart muscle
It got a miniaturized pulse generator and is powered by small
batteries.
Types of implantable Pacemaker
1)Fixed Rate Pacemaker-this type of pacemaker is intended for
patients having permanent heart blocks.
• The rate is preset but the rate can be varied externally in implanted
units by magnetically actuating a built in relay.
• Cause potential danger to patient because of the competition with
natural pacemaker.
2)Demand pacemaker-they avoid competition with natural
pacemaker.
• They function only when the R-R intervals of the natural rhythm
exceed a preset limit.
3)R wave triggered pacemaker-the ventricular synchronized demand
type (R wave triggered) is meant for patients who are generally in
heart block with occasional sinus rhythm.
4)Ventricular inhibited or R wave Blocked Pacemaker-for patients
who generally have sinus rhythm with occasional heart rhythm.
5)Atrial triggered Pacemaker-the pacemaker detects atrial
depolarization and starts the pulse forming circuit after a delay so that
the impulse to the ventricles delivered after a suitable PR interval.
6)Dual Chamber Pacemaker-In these devices both atria and ventricles
are sensed and stimulated as needed while maintaining the proper
rhythm of upper and lower rhythm.
Classification code for Pacemaker

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