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8.REFERENCES
[1] https://www.nhlbi.nih.gov/health/pacemakers/who-needs
[2] https://www.slideshare.net/vijayvandali/pacemaker-89245503?from_action=save
[3] https://youtu.be/53_jyoA47Fk
[4] https://link.springer.com/chapter/10.1007/978-0-387-72763-9_2
[5] https://youtu.be/54taja_HveU
[6] https://youtu.be/WgKCUjPcDY0
[7] https://youtu.be/2w3V4FPqlwU
[8]
https://www.yashodahospitals.com/blog/pacemaker/#:~:text=Conclusion,and%20slowing
%20down%20at%20rest
[9] https://youtu.be/tUtg5p64Y-A](https://image.slidesharecdn.com/pacemakerperfect11-231115132726-d3f05f45/85/pacemaker-perfect-1-1-pdf-23-320.jpg)
pacemaker perfect (1) (1).pdf
- 1. 1 A Technical Seminar Report On PACEMAKER Submitted in partial fulfilment of the requirement for the award of Bachelor of Technology In Electronics and Communication Engineering BY ANJALI DHARMINI (20251A0463) DEPARTMENT OF ELECTRONICS & COMMUNICATION ENGG G. NARAYANAMMA INSTITUTE OF TECHNOLOGY & SCIENCE (for women) (Autonomous) Accredited by NAAC & NBA Batch: 2020-2024
- 2. 2 CONTENTS S. No Topic Page No Abstract i List of Figures ii List of Abbreviations iii 1 Introduction 1.1 History of pacemaker 6 1.2 Overview 6-7 2 Detailed description 2.1 Temporary pacing 9 2.2 Permanent pacing 9-11 2.3 Pacing lead 11-16 2.4 Complications 16 3 Indications 3.1 Bradycardia 17 3.2 Other indications 17-18 4 Configurations 4.1 single chamber pacemaker 19 4.2 Dual chamber pacemaker 19 4.3 Biventricular pacemaker 19-20 4.4 Implantable pacemaker 20 5 Pulse Generator 5.1 Parts 21 5.2 Working 21 6 Applications and problems 22 7 Conclusions 23 8 References 24
- 3. 3 ABSTRACT Certain congenital heart defects , enlarged or thick heart muscle that makes it harder to pump blood out of your ventricles, heart attack ,heart failure these problems may cause your blood pumping system to work inefficiently which may arise the need to use a pacemaker. A pacemaker is an electronic device which carries out a heart’s functionality. Many advanced and improved versions of pacemakers are invented. This research does the analysis on the questions related to pace makers like how they are made? technology used? Why do we need them? When do we need them? What are the improvements? What are the problems arising by using them? Can we overcome them? Will anything replace the pacemaker? What are types of pacemakers? Basic pacemaker consists of three parts: pulse generator, electrode, one or more leads and remote monitoring pacemakers. Keywords:- remote monitoring, pulse generator, congenital heart defects. Name:-Anjali Dharmini Roll No:- 20251A0463
- 4. 4 LIST OF FIGURES S. No Fig No. Name of the fig Page No. 1 1.1 Pacemaker 6 2 1.2 Implanted Pacemaker 7 3 2.1 Temporary Pacing 9 4 2.2 Permanent Pacing 10 5 2.3 Bipolar ECG 12 6 2.4 Ventricular demand pacing 13 7 2.5 Synchronous Pacing 13 8 2.6 Atrioventricular sequential pacing 14 9 3.1 Mobitz type 2 AV block 17 10 3.2 Third degree heart block 17 11 3.3 Heart failure 18 12 3.4 HCM 18 13 4.1 Single chamber pacemaker 19 14 4.2 Dual chamber pacemaker 19 15 4.3 Biventricular pacemaker 20 16 4.4 Implantable pacemaker 20 17 5.1 Simple pacemaker 21 18 5.2 Applications 22
- 5. 5 LIST OF ABBREVIATIONS S.No. Abbreviation Full Form 1 HCM Hypertrophic cardio myography 2 ECG Electro cardiogram 3 ICD Implantable cardioverter- Defibrillator 4 DDD Dual Chamber pacing
- 6. 6 1.INTRODUCTION 1.1 History of pacemaker The history behind the artificial pacemaker stretches back over 300 years. As a critical component of numerous scientific developments in medicine, specifically within cardiology, the pacemaker and its history have provided a foundation for basic electrophysiology, applied electrotherapy and various treatment technologies devoted to reducing both the mortality and morbidity of many diseases. 1.2 OVERVIEW: • A pacemaker is a small device that's placed (implanted) in the chest to help control the heartbeat. It's used to prevent the heart from beating too slowly. Implanting a pacemaker in the chest requires a surgical procedure. • A pacemaker is also called a cardiac pacing device. • Pacemakers work only when needed. • Pacemakers consist of 2 parts pulse generator and electrodes. Fig:1.1 Pacemaker
- 7. 7 • It's unlikely that your pacemaker would stop working properly because of electrical interference. Still, you'll need to take a few precautions. • Cell phones effects the working of pacemakers causing electrical disturbances. PACEMAKERS: A pacemaker is a small device used to treat some arrhythmias. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Pacemakers send electrical pulses to help your heart beat at a normal rate and rhythm. Pacemakers can also be used to help your heart chambers beat in sync so your heart can pump blood more efficiently to your body. This may be needed if you have heart failure. Fig 1.2 Implanted Pacemakers
- 8. 8 9 2.DETAILED DESCRIPTION A pacemaker is a battery operated generator that initiates and controls electrical stimulation of the heart via an electrode that is usually in direct contact with the myocardium. 2.1.TEMPORARY PACING: The pulse generator is external and the pacing electrode is inserted by transvenous, or transcutaneous route either at the beside or under fluoroscopy. THE TRANSVENOUS ROUTE, which is preferred in emergency situations, requires a hard tipped or balloon -tipped pacing lead to be guided into the right heart and into contact with the endocardium. Temporary transvenous pacing wire in right ventricle inserted through antecubital vein. Transvenous installation of a permanent pacemaker. For dual -chamber pacing a separate pacing wire would be in the antrim. PERMANENT PACING In an operating room, the pulse generator -a small hermetically sealed, lithium battery weighing from 30-130 gm-is placed into a small tunnel burrowed with the subcutaneous tissue below the right clavicle (less frequently the left clavicle). The pacing electrode is inserted via a transvenous route (most common ) or directly applied to the epicardial surface by thoracotomy. Fig 2.1 Temporary Pacing
- 9. 9 The inter society commission for heart disease established a code to create uniform descriptions of pacemaker function. First letter: Indicates which chamber is paced : V: ventricles A: altruism D: dual (both atrium and ventricle) Second letter : Indicates which chamber is sensed V: ventricles A: atrium D: dual(both atrium and ventricle ) O: no sensing Third letter: Indicates the mode (how the pacemaker responds to intrinsic heart pulses ) I: inhibited response T: trigger response D: dual response – inhibited for some sensed impulses and trigger for others R: reverse- pacer is activated to send out impulses during fast intrinsic heart rates instead of slow O: no response to sensed impulses. Fourth letter: Indicates programmable function P: programmable M: multiprogrammable C: multiprogrammable with telemetry Fig 2.2 Permanent Pacing
- 10. 10 O: none Fifth letter: Indicates special tachycardia function B: bursts N: normal rate competition S: scanning E: external Examples of temporary pulse generators. Single – chamber pulse generator. Dual chamber pulse generators. The impulse generator is said to capture the myocardium and there by maintain heart rhythm. 2.3 PACING LEADS UNIPOLAR PACEMAKER: Lead has only one electrode that contacts the heart at its tip pole. The power source is the pole. Patient serves as the grounding source. Patients body fluids provide the return pathway for the electrical. Signal electromagnetic interference occurs more often in unipolar leads. BIPOLAR LEADS If bipolar, there are two wires to the heart or one wire with two electrodes at its tip. Provides a built – in ground lead circuit is completed within the heart provides more contact with the endocardium ; needs lower Current to pace less chance for cautery Fig 2.3 Unipolar and Bipolar
- 11. 11 BIPOLAR PACING SYSTEM The atrium is paced and the ventricle is allowed to be depolarization via conduction of the paced atrial impulse through the normal pathway of the A-V node and the his- purkinje conduction system. Atrial demand pacing is useful in symptomatic sinus bradycardia of any kind. VENTRICULAR DEMAND PACING Patients with episodic A-V block may benefit from ventricular demand pacing. When spontaneous ventricular depolarizations fall below the preset pacemaker rate,paced ventricular depolarizations ensure. Disadvantage is the loss of atrial ventricular synchrony and the atrial kick. Fig 2.4 Bipolar ECG Fig 2.5 Ventricular Demand Pacing
- 12. 12 SYNCHRONOUS PACING Synchronous pacing was the first mode developed to offer dual chamber pacing. Sensing occurs in both atrium and ventricle. when a p wave is sensed, a ventricular output pulse is triggered after a preset atrioventricular interval. If a spontaneous QRS complex is sensed, the paced output is inhibited, thus preventing competitive pacing in the ventricle ATRIOVENTRICULAR SEQUENCIAL PACING: In this mode sensing occurs only in the ventricle while pacing occurs sequentially in the atrium and after a preset AV interval, in the ventricle. If spontaneous ventricular depolarization follows quickly enough after the paced atrial beat, inhibition of the ventricular output pulse occurs. Fig 2.6 Synchronous Pacing Fig 2.7 ATRIOVENTRICULAR SEQUENTIAL PACING
- 13. 13 UNIVERSAL ATRIOVENTRICULAR PACING If spontaneous atrial activity does not take place within the preset time limit , atrial pacing triggered . Any sensed intrinsic atrial activity inhibits the paced atrial pulse . If ventricular depolarization in response to a spontaneous or paced atrial beat does not occur within a present interval, a ventricular stimulus is issued by the pacemaker. Intrinsic ventricular activity occurring within the pre-set time interval inhibits the paced ventricular stimulus. This pacing is indicted in atrial brady arrhythmia with or without abnormal AV conduction or in normal sinus node function with AV block. It allows the atrial kick. It adjust heart rate to meet the metabolic demands of the body. ECG Fig 2.8 ECG
- 15. 15 3.INDICATIONS 3.1.BRADYCARDIA: Bradycardia (brad-e-KAHR-dee-uh) is a slow heart rate. The hearts of adults at rest usually beat between 60 and 100 times a minute. If you have bradycardia, your heart beats fewer than 60 times a minute. Bradycardia can be a serious problem if the heart rate is very slow and the heart can't pump enough oxygen-rich blood to the body. If this happens, you may feel dizzy, very tired or weak, and short of breath. Sometimes bradycardia doesn't cause symptoms or complications. 3.2.OTHER INDICATIONS (TO USE A PACEMAKER ): • Mobitz type 2 AV block • Third degree heart block Fig 3.1 Mobitz type 2 AV block Fig 3.2 Third degree heart block
- 16. 16 • Heart failure (Biventricular pacemaker) Fig 3.3 Heart failure • Hypertrophic obstructive cardio myography (implantable cardioverter defibrillator): Hypertrophic cardio myography (HCM) is a disease in which the heart muscle becomes thickened (hypertrophied). The thickened muscle makes it harder to heart to pump blood. Fig 3.4 HCM
- 17. 17 4.CONFIGURATIONS There are different configurations based on the number of leads used in the pace maker 4.1. SINGLE CHAMBER PACEMAKERS: This type usually carries electrical impulses to the right ventricle of your heart. 4.2. DUAL CHAMBER PACEMAKER: This type carries electrical impulses to the right ventricle and the right atrium of your heart to help control the timing of contractions between the two chambers. Fig 4.1 Single Chamber Pacemaker Fig 4.2 Dual Chamber Pacemaker
- 18. 18 4.3 BIVENTRICULAR PACEMAKER: Biventricular pacing, also called cardiac resynchronization therapy, is for people who have heart failure and heartbeat problems. This type of pacemaker stimulates both of the lower heart chambers (the right and left ventricles) to make the heart beat more efficiently. 4.4 IMPLANTABLE PACEMAKERS: Fig 4.3 Biventricular Pacemaker Fig 4.4 Implantable Pacemakers
- 19. 19 5.PULSE GENERATOR 5.1. PARTS: ● A power source in the form of a battery ● Circuitry (output, sensing, telemetry, microprocessor or microsequencer, memory) ● A metal casing (can) welded shut to keep out fluids ● A feedthrough (a piece of wire surrounded by glass or sapphire) that maintains a hermetic seal to provide an electrical connection through the can ● A means of connecting a pacing lead (wire to the heart) to the header of the pacemaker ● Sensors (e.g., acceleration, vibration, impedance) 5.2. WORKING: A cardiac pulse generator is a device having a power source and electronic circuitry that produce output stimuli. Functionally, at its simplest, current sourced by the device’s battery travels through a connecting pathway to stimulate the heart and then flows back into the pacemaker to complete the circuit. Fig 5.1 Simple Pacemaker
- 20. 20 6. APPLICATIONS AND PROBLEMS 6.1. APPLICATIONS: By regulating the heart’s rhythm, a pacemaker can often eliminate the symptoms of bradycardia. This means individuals often have more energy and less shortness of breath. However, a pacemaker is not a cure. It will not prevent or stop heart disease, nor will it prevent heart attacks. Fig 6.1 Applications
- 21. 21 6.2 PROBLEMS: • Irregular working of pulse generator • Bruising • Bleeding • Pain around the incision • Infection • The pace maker lead moving • Blood clots (thromboembolism) near the pacemaker site. • Damage to blood vessels or nerves near the pacemaker. • Collapsed lung (pneumothorax)
- 22. 22 9 7.CONCLUSIONS Many abnormal heart rhythms can be treated with a pacemaker. A pacemaker generates electric pulses that regulate heartbeats. Thanks to advances in technology, pacemakers are very light and can adapt to your body needs, moment by moment, beating faster during exercise and slowing down at rest. The procedure to insert a pacemaker is fairly simple and safe. Complications are rare, but knowing about them may help you to detect them early if they happen. After the procedure, you can go back to your regular activities after a short period of healing time. But due to lead disadvantages people even getting ICD.
- 23. 23 8.REFERENCES [1] https://www.nhlbi.nih.gov/health/pacemakers/who-needs [2] https://www.slideshare.net/vijayvandali/pacemaker-89245503?from_action=save [3] https://youtu.be/53_jyoA47Fk [4] https://link.springer.com/chapter/10.1007/978-0-387-72763-9_2 [5] https://youtu.be/54taja_HveU [6] https://youtu.be/WgKCUjPcDY0 [7] https://youtu.be/2w3V4FPqlwU [8] https://www.yashodahospitals.com/blog/pacemaker/#:~:text=Conclusion,and%20slowing %20down%20at%20rest [9] https://youtu.be/tUtg5p64Y-A
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