artificial cardiac pacemaker
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What is an Artificial Cardiac Pacemaker?
not to be confused with the heart's natural pacemaker!!!
Rounak Patra
13MS106
History of Pacemaker
1932 Albert Hyman Concept of artificial pacemaker, magneto-generator to power
up electrode.
1950 John Hopps 1st transcutaneous pacemaker.
Vaccum tube technology and direct AC power supply is used.
1958 Earl Bakken 1st wearable transistorized pacemaker.
1958, 8th
October
Dr. Ake Senning
Dr. Rune Elmquist
1st implanted (trans-venous) pacemaker.
1959 W.M. Chardack
Wilson Greatbatch
1st successful long term implantable pacemaker.
1970 Introduction of Li-Iodide battery technology.
1980 Introduction of rate responsive pacing.
History of Pacemaker
Arne Larsson (1915–2001) became the
first to receive an implantable pacemaker
(1958). He had a total of 26 devices
during his life.
Sinus Node Dysfunction
Sinus bradycardia
Sinus arrest
SA block
Brady-tachy syndrome
Chronotropic incompetence
(CI)
AV Block
• First-degree AV block
• Second-degree AV block(Mobitz types I and II)
• Third-degree AV block
Device construction and materials
A Pacemaker System consists of a
• Pulse Generator & Power Source
• Pacing Leads or wires
Type based terminologies1. Asynchronous/Fixed Rate
• It delivers an electrical impulse at a present fixed rate to the heart.
• Occurs in non-sensing modes.
• Functions independently of cardiac activity.
• The pulse generator delivers artificial stimulus only when intrinsic pacemaker fails to function (at a predetermined rate).
• Does not compete with patient’s rhythm.
2. Synchronous/Demand
Single-Chamber System
• The pacing lead is implanted
either in the atrium or
ventricle, depending on the
chamber to be paced and
sensed.
• Single ventricular lead does not
provide AV synchrony.
• One lead implanted in the
atrium.
• One lead implanted in the
ventricle.
• Provide AV synchrony.
• Atrio-ventricular (AV)
Sequential (Dual Chamber)
provide sufficient AV delay
to permit adequate
ventricular filling.
Dual-Chamber System
Rate responsive pacing
When the need for oxygenated blood increases,
the pacemaker ensures that the heart rate
increases to provide additional cardiac output.
Recent advances in pacemaker technology
• MRI-compatible pacemaker called the Revo MRI SureScan.(Also
prevent damage from radio waves and magnet)
• Upgrade in Rate Responsive modes: Dynamic AV delay feature
that automatically adjusts on a cycle-by-cycle basis to mimic
physiologic response.
• Leadless pacemaker: Nanostim, 10 times smaller than the
conventional pacemaker which can be repositioned easily (devoid
of lead failure etc.) and quality of the life for patient is
significantly improved due to no restrictions of activity.
ADVERSE EFFECTS
1. Pacemaker syndrome
2. Infection
3. Venous thrombosis
4. Air embolism and Hematoma
5. Lead dislodgement and Perforation via
pacemaker lead.
6. Pneumothorax
• The Evolution of Pacemakers by Sandro A.P. Haddad, Richard P.M.
Houben, And Wouter A. Serdijn.
• Guyton and Hall Textbook of Medical Physiology 12th Edition.
• http://www.pacemaker.vuurwerk.nl/info/nbg_code__naspe.htm
• Recent advances in pacemaker and implantable defibrillator therapy
for young patients. Walsh EP, Cecchin F.
• Basic Principles of Cardiac Pacemaker Technology- Springer.
• Pulse Output by Michael K. Laudon
• Pacemaker Overview by Stuart Allen.
• https://www.nhlbi.nih.gov/health/health-topics/topics/pace
• https://en.wikipedia.org/wiki/Artificial_cardiac_pacemaker
References
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