cardiac pacemakers © d. j. mcmahon 2012 rev 121010
TRANSCRIPT
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Cardiac Pacemakers
© D. J. McMahon 2012 rev 121010
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History –
1952 - Zoll: stimulation of heart thru chest wall
1957 - Lillehei: direct stimulation by leads on the heart from an external pacemaker
1958 - Greatbatch: made first fully implantable pacemaker
1986 - Medtronic Corp: first rate-responsive pacemaker
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The problem: Arrhythmias
Types of arrhythmia:
> Conduction Problem - delay at the SA node pacemaker - deflected path of the signal - block of the path 1° Block: long delay 2° Block: intermittent block of the signal 3° Block: complete blockage of the signal
> Problem at the Origin of the Signal - erratic rate at the SA node - multiple pacemaker sites - high rate (“sinus tachycardia”) - low rate (“sinus bradycardia”)
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Examples :
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Pacemaker Types:
Implanted:Entire unit surgically installed within the chest
External Invasive:Leads in the heart, pacemaker assembly external
Transcutaneous:Entire pacemaker external; signal thru the chest wall
Automatic Implantable Cardiac Defibrillator (AICD):Not a true pacemaker, but monitors the heart rate and sends adefibrillation signal if and when the heat goes into fibrillation
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Pacemaker Modes:
Asynchronous: provides pulses at a fixed rate
Demand: provides pulses when the heart fails to beat
Rate-Modulated: provides pulses based on the heart’s current activity
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Pacing markers
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AICD
pacemakers
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Modern implantable pacemakers are programmable through telemetry or magnetic signaling, and most store months worth of history of heart activity which can be retrieved noninvasively.
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