Artificial Pacemaker

Natural Pacemaker:

The rhythmic action of the heart is started by periodic recurring action potentials due to
Electrochemical impulses originating at the natural cardiac pace maker called Sinoartial node.(SA
node). Each pacing impulse is propagated into entire myocardium, spreading over surface of atria to
atrial ventricular node( AV node). After a delay at AV node, the impulse is rapidly conducted to the
ventricles to depolarize the ventricular muscles. The healthy heart beat i.e..NSR (Normal Sinus
Rhythm) is based on performance of SA node. Any change in NSR is called as arrhythmia
(abnormal rhythm)

Bradycardia:

Due to SA node disease heart beat is much paced at lower rate than the normal range between
30 to 50 beats per minute (BPM). Under this condition heart cannot pump sufficient blood to meet the
demand. Due to which dizziness, loss consciousness occurred.

Heart block:
Heart block is classified into three types

First degree block:

An excessing impulse delay at AV node occurs that causes PR intervals in ECG to exceed 0.2
sec.
Second degree block:

Intermittent complete inhibition of pacing impulse at AV node.

Third degree block

Its other name is complete heart block. Total signal blockage at any conduction block.

In all these conditions, pacing is generally required to ensure sufficient blood circulation to entire
body. A device capable generating pacing impulses and delivering then to heart . It is called as
Artificial Pacemaker. It consists of pulse generator and appropriate electrodes. Electrical pulses are
generated by pacemaker applied directly to chest or internally to heart muscle.

In cardiac stand still pacemaker is used temporarily and electrical impulses externally to chest. This
type of pacemakers are called as External Pacemaker.

In terms of long term pacing , the pacemaker is surgically implanted into the body and electrodes are
in direct contact with heart. This type of pacemaker is called Internal Pacemaker

Competitive pacing:

The competitive pacing is used to compete with natural pulse generated (may be weak) in the heart.
This simplest pacemaker is asynchronous pacemaker and it produces pulses at fixed rate independent
of cardiac pulses. The battery life is short due to continuous constant operation.

Non-Competitive Pacing :

Here control of heart will be either ventricular program or articular program

Ventricular- programmed R- wave inhibited (demand) type:

Suppose no R-wave is generated, the pacemaker will generate to activate heart.

Ventricular- programmed R-wave Trigger (standby):

The impulse produced to strengthen the natural R- pulse.

Atrial Programmed P- wave Synchronised:

In place of complete heart block where atria used to depolarise but impulse depolarise the ventricles,
Atrial synchronous pacing is required.

Modes of operation of Artificial pacemaker:

Pacing Modes: VVI, VVT, VOO, OVO, AAI, AAT, AOO, OAO, VVIR, V VTR, VOOR,
AATR, AOOR, AAIR
Basic Pacing Rates: From 32 to 120 bpm in steps of 2 bpm.
Pulse Widths: 20 values from 0.07 to 1.50 msec.
Pulse Amplitudes: 36 values from 0.2 to 7.5 Volts
Pacing Polarity: Unipolar/Bipolar
Sensitivities: From 0.4 to 6.4 mV in steps of 0.4 mV
Sensing Polarity: Unipolar/Bipolar
Refractory Periods: From 200 to 500 msec in steps of 15 msec.
Hysteresis: From 2 to 40 per min in steps of 2 per min or disabled.
Hysteresis Search: When enabled, every 700 stimuli produces a Hysteresis period.
Upper Rate in Trigger Mode: From 80 to 180 per min in steps of 2 per min
Upper Rate: From 80 to 180 per min

BLOCK DIAGRAM

Embedded computer system is hardware/software codesign with dedicated processor. As

most of the embedded portable devices are battery operated, low power design methodology
plays a crucial role in design. A large number of embedded computing applications are power
critical and power constraints form an important part of the design specification. Processor is
an important computing element in battery operated real time embedded system and
consumes most of the battery energy [7]. Even with advanced battery technology, power
budget is limited. Appropriate /optimized software design and analysis became a latest trend
in modern embedded systems.

Basic blocks of implantable pacemakers are ECG front end circuitry, ultra low power
microcontroller, battery and output circuitry to stimulate heart. Heart signal is sensed by
electrodes. Main emphasis must be given on size, weight, encapsulating material and increase
in life span of battery i.e. up to 10 to 12 years. The front end senses voltage generated by the
pumping action of the
heart which is small signal with many noise components. This circuit consists of differential
amplifier, filter, level shifter, synchronizing circuit etc. To pace abnormal heart with a pulse
of 5 to 7.5 volts, multiplier along with switch network is used. Implantable pacemaker
consists of external comparator.
Cardiac signal is sensed by unipolar or bipolar electrodes and is amplified by a low noise pre-
amplifier, gain amplifier. It is filtered by second order low pass filter to get appropriate ECG.
This signal is applied to the comparator. Comparator is used as a threshold detector, to detect
the heart beat event executed by the heart and generates a pulse with every heartbeat.
External comparator consists of two inputs i.e. ECG and threshold voltage. It generates pulse
depending on the threshold
voltage level. In the absence of heart signal no pulse is generated. Comparator output
(synchronizing pulse) is connected to the 2.0 port of the MSP 430F1611 processor. Output
stage called charge pump, consists of voltage multiplier/pulse generator to stimulate heart. A
high voltage pulse of 5 to 7.5Volts is delivered to the heart through pacing electrodes. The
amplitude and pulse width must be customized for each patient. Supply Voltage Supervisor
(SVS) is necessary to monitor battery voltage. Various blocks customized as shown in figure
2, are integrated in MSP 430F1611 ultra low powermicrocontroller.
VLSI based analog/digital custom processor and interfacing peripherals are used in
implantable pacemaker [1]. It increases cost and time to market. Some ultra low power
microcontrollers are available today which will be better choice for crucial biomedical
applications.
Pacemaker is a computer controlled real time system with predefined tasks priority.
Microcontroller with optimized software is basic component in it. Microcontroller to be
chosen must have low power consumption and required memory space. ARM is very
important processor in modern embedded system. It has features like low power
consumption, high speed, code size optimization using thumb and ARM mode, Dynamic
voltage Scaling (DVS) functionality for energy consumption optimization [5]. Incomparison
with ARM, MSP430F1611 is a 16 bit RISCprocessor which has features like ultralow power
consumption, speed of 8 MHz lesser than ARM, but suitable to handle heart signal, and
various power down modes. It has standby current , lesser than that for PIC181f242, and
Maxq 2000 processors. Lithium Iodine batteries are standard in modern pacemaker.

MSP430 F1611:
The Texas instruments MSP430 family of mixed signal micro controller has 3-stage
pipe line , 16 bit data processing (RISC), Von Neumann CPU architecture.
It consists of inbuilt peripherals.
The MSP 430F1611 has two 16 bit timers, a high performance 12 bit A/D converter,
dual 12 bit D/A converters, one USART, DMA, 48 I/O pin s, comparator and supply
voltage supervisor.
The device is a powerful 16 bit RISC CPU with 16 registers.
 The digitally control led oscillator (DCO) has a wake up time of 6 micro second to
shift from low power modes to active mode.
It has five low power modes to extend battery life in portable biomedical applications.
Low power modes LMP0 turned off CPU and leave everything else functional.
Modes LPM1 and LPM2 add various clocking functions to the list of disabled
functions.
LPM3 is the most used low power mode leaving only a low frequency clock
oscillator running and any peripheral that uses that clock.
LPM3 is often called the real time clock mode because it allows a timer to operate for
low power 327658 Hz clock source consuming less than 1 A and periodically wake
the system for activity.
Finally LPM4 turns off all clocks on the device thus turning off any peripheral that
used clocks automatically.

MSP430 series has 27 basic instructions.

MSP430 F1611 needs 2.21Volts core voltage and has clock period of 125 nanosec.
There are two timers in MSP430.
Timer A
Timer B
Timers A and B are used to count interval and generate interrupts accordingly
Low power consumption is a crucial constraint
some functionalities, like basic pacing, pulse width and refractory period in VOO
mode, has been realized using MSP430F1611 ultralow power processor.
Appropriate measuring and modeling scheme has been implemented to measure
instantaneous current and to derive energy consumption.
 The work is aimed towards development of low power processor based implantable
pacemaker and estimation of software related current/ energy consumption.

DIAGNOTIC TESTS:

A number of tests are used to detect an arrhythmia. Your doctor may recommend some or all
of these tests.

EKG (Electrocardiogram)

This simple and painless test detects and records the electrical activity of the heart. An EKG
shows how fast the heart is beating and the heart's rhythm (steady or irregular). It also records
the strength and timing of electrical signals as they pass through each part of the heart.

Echocardiogram

This test uses sound waves to create a moving picture of your heart. An echocardiogram
shows the size and shape of your heart and how well your heart is pumping blood. The test
can identify areas of heart muscle that aren't contracting normally or getting enough blood
flow.

Stress Test

Some heart problems are easier to diagnose when your heart is working harder and beating
faster than when it's at rest. During stress testing, you exercise to make your heart work
harder and beat faster while heart tests, such as an EKG or echocardiogram, are performed.

TYPES OF PACEMAKER PROGRAMMING

There are two main types of programming for pacemakersdemand pacing and rate-
responsive pacing.

A demand pacemaker monitors your heart rhythm. It only electrically stimulates your heart if
its beating too slow or if it misses a beat.

A rate-responsive pacemaker will speed up or slow down your heart rate depending on how
active you are. To do this, the rate-responsive pacemaker monitors your sinus node rate,
breathing, blood temperature, or other factors to determine your activity level. Most people
who need a pacemaker to continually set the pace of their heartbeat have rate-responsive
pacemakers.

What Are the Risks of Pacemaker Surgery?

Your chance of having any problems from pacemaker surgery is less than 5 percent. These
problems may include:

Swelling, bleeding, bruising, or infection in the area where the pacemaker was placed
Blood vessel or nerve damage
 A collapsed lung
A bad reaction to the medicine used to make you sleep during the procedure
Infections that can become difficult to treat

How Will a Pacemaker Affect my Lifestyle?

Once you have a pacemaker, you have to avoid close or prolonged contact with electrical
devices or devices that have strong magnetic fields. Devices for which close and prolonged
exposure can interfere with a pacemaker include:

Cell phones
iPods
Appliances, such as microwave ovens
High-tension wires
Metal detectors
Industrial welders
Electrical generators

These devices can disrupt the electrical signaling of your pacemaker and stop it from working
properly. You may not be able to tell whether your pacemaker has been affected.

To be on the safe side, some experts recommend not putting your cell phone or iPod in a shirt
pocket over your pacemaker (if they are turned on). You may want to hold the cell phone up
to the ear thats opposite the site where your pacemaker was implanted. If you strap your
iPod to your arm while listening to it, put it on the arm farthest from your pacemaker.

You can still use household appliances, but avoid close and prolonged exposure, as it may
interfere with your pacemaker.

You can walk through security system metal detectors at your normal pace. You also can be
checked with a metal detector wand as long as it isn't held for too long over your pacemaker
site. You should avoid sitting or standing close to a security system metal detector.

Stay at least 2 feet away from industrial welders or electrical generators.

You also need to avoid some medical procedures that can disrupt your pacemaker. These
procedures include:

Magnetic resonance imaging (also called MRI)

Shock-wave lithotripsy to get rid of kidney stones
Electrocauterization to stop bleeding during surgery

Follow-up:

Your doctor will want to check your pacemaker regularly. Over time, a pacemaker can stop
working properly because:

Its wires get dislodged or broken

 Its battery fails
Your heart disease progresses
Devices giving off strong electrical, magnetic, or radio waves have disrupted its
electrical signaling

To check your pacemaker, your doctor may ask you to come in for an office visit several
times a year. Some pacemaker functions can be checked remotely through a telephone call or
a computer connection to the Internet. Your doctor also may ask you to have an EKG
(electrocardiogram) to monitor changes in the electrical activity of your heart.

ADVANCEMENT IN PACEMAKERS AND FUTURE SCOPE:

Implantable Cardioverter-Defibrillator:

The process of implantation of an ICD is similar to implantation of a pacemaker. Similar to

pacemakers, these devices typically include electrode wire(s) which pass through a vein to
the right chambers of the heart, usually being lodged in the apex of the right ventricle. The
difference is that pacemakers are more often temporary and
generally designed to consistently correct bradycardia, while
ICDs are often permanent safeguards against sudden
abnormalities.

The most recent development is the subcutaneous ICD (S-

ICD). Current state-of-the-art electronics and batteries have
enabled an implantable device to deliver enough energy to
defibrillate the heart without the need for a lead in or on the
heart. This prevents lead-related problems and the risk of
dangerous infections in or near the heart. This ICD is
positioned just under the skin and outside the ribcage.

Working mechanism:

ICDs constantly monitor the rate and rhythm of the heart and can deliver therapies, by way of
an electrical shock, when the electrical manifestations of the heart activity exceeds the preset
number. More modern devices can distinguish between ventricular fibrillation and ventricular
tachycardia (VT), and may try to pace the heart faster than its intrinsic rate in the case of VT,
to try to break the tachycardia before it progresses to ventricular fibrillation. This is known as
fast-pacing, overdrive pacing, or anti-tachycardia pacing (ATP). ATP is only effective if the
underlying rhythm is ventricular tachycardia, and is never effective if the rhythm is
ventricular fibrillation.

MRI-compatible pacemaker:
Before the new pacing system was available, MRI procedures were not possible for patients
with implanted pacemakers because of the potential for serious complications, including
interference with pacemaker operation and possible damage to device components. A
pacemaker monitors the electrical impulses in the heart and delivers electrical pulses to make
it beat in a normal rhythm.

Medical imaging and electronic implantable devices, such as pacemakers, are important
technological advances, and are often life-saving, said William Sauer, MD, director of
cardiac electrophysiology at UCH. MRI conditionally
safe pacemakers are an important step towards providing
our patients the highest level of care, without compromise.
UCH patients now have access to this revolutionary
technology. They no longer have to choose between a
device to monitor their heart and improve their quality of
life or a scan that could ultimately be life-saving.

Internet Used In Pacemaker Advancement:

If you have pacemaker, or know of anyone who has one
then you know what a pain they can be. Having to be examined when going in for a
checkup.Well, there looks to be a shining light against the problems of pacemakers. Because,
the first internet connected pacemaker is hooked up, and online. The device is hooked up
to a New York woman, and so far things are looking good.

Her pacemaker is setup on a special medical frequency, as not to interfere with other electronic
devices. The internet connection provides her doctor with easy notification of any problems. Also, her
checkups can be done remotely through the devices equipment.

Tattooing Patients With UV Ink Could Protect Pacemakers From Hackers:

More and more implantable devices, like pacemakers or defibrillators, are turning to wireless signals
as a means to communicate with external devices, but in doing so they open themselves to security
breaches.

So Microsoft Research proposes putting a new technological spin on an old, time-tested security
protocol: protect every device with a password, then tattoo the password right onto the patient in
invisible UV ink.

Laser Pacemaker:
For the first time, scientists have used light pulses to control a living animal's heartbeat, in a
breakthrough that could lead to a greater understanding of
congenital heart defects and even optical pacemakers.

Using laser pulses, they were able to pace the heart's contractions,
with no apparent damage to the developing tissue.

How the laser pacemaker works: 1) A microprocessor in an

embedded catheter listens to the heart. 2) If it picks up an
irregular heartbeat, an LED sends a signal to the pacemaker
to fire its laser. 3) The energy from the laser is converted to
electricity via electrodes that stimulate the heart.

If you have a pacemaker monitoring your heart, you'd better

hope nothing goes wrong with your mind. That's because
MRIsthe most effective way to image the brainand
pacemakers don't mix. The former heats the device's
implanted metal wires so much they could scar the heart or
trigger a rapid heartbeat.
REAL TIME EMBEDDED SYSTEM

(ARTIFICIAL PACEMAKERS)

Submitted by

C.Mohan Sriram,

G.Anand

A.Prabhakaran