Any living organism’s heart is one of the most important body parts. A human heart is made up of two pumps that are housed within an organ. In an average adult, around 5 liters of blood is pumped each minute while they are resting. This is based on a 72-beat-per-minute average beat rate. A healthy person’s heart rate can reach 200 beats per minute during activity.
The body regulates the heartbeat to ensure that the organs’ oxygen requirements are met. This requirement is triggered by any physical or mental actions that a person engages in. Multiple disorders have been identified in the medical community when the heart fails to maintain the proper beat rate. Arrhythmia is the term for this condition. Arrhythmias or cardiac disorders affect more than 4 million Americans (USNews, 2019) and 2 million Britons (NHS, 2019).
The following are the different types of Heartbeats
Tachycardia refers to a heartbeat that is extremely fast, whereas bradycardia refers to an extremely sluggish heartbeat. Various body areas may not receive enough blood from the heart during bradycardia, leading to shortness of breath and exhaustion, which is prevalent in people with cardiac problems. Furthermore, because of the extreme severity of arrhythmias, critical organs of the body stop functioning properly, and death may occur.
Pacemaker technology is a hot topic in the scientific community right now. A pacemaker is a very successful way to restore regular heartbeats, allowing the patient to live a vibrant and active life without having to worry about breathing problems.
Artificial pacemakers are electronic devices that generate electrical impulses to stimulate the heart and restore or maintain a normal rhythm. It regulates the heart’s pumping function by restoring the connection between the atria and ventricles, resulting in a significant boost in survival capacity. It is used to deal with branchardia and tachyarrhythmia. It has a sensor that keeps the level of periodic signal constant.
Components of a conventional pacemaker
A pacemaker’s two major components are the electrical pulse generator and the pacemaker electrodes (leads). The circuits and power sources required to determine the heart rate as well as the intensity of the electrical stimulus delivered to the heart are included in the former. Through endocardial leads and epicedial wires, the latter is in charge of transferring the generated impulses to the heart.
It was essential to split open an existing pacemaker to learn how it works. The apparatus is powered by a semi-coin cell battery. The majority of the circuitry is made up of surface mount components, which allows the system to take up as little space as possible. The circuitry of the pacemaker is made up of very efficient pieces that require very little energy to extend the battery life.
Material for Casings
Titanium is one of the most important materials used in pacemaker manufacturing. Titanium’s other properties, such as its excellent durability, strength, and extended life, all contribute to the pacemakers’ long lifespan.
The most important factor in deciding how long pacemakers last is the battery life. It’s impossible to develop a pacemaker that needs to be maintained regularly. Simultaneously, the device will be placed close to the heart, preventing the use of any dangerous compounds.
Block with Connectors
The pacemaker generates the pulses, which are then transmitted via the leads. The pacemaker has a connecting block that secures the leads. This block guarantees that the pulses are effectively transmitted by the leads. Polyurethane is used to create the connecting block.
Pacing leads are used to provide electrical pulses from a pacemaker. The fixation mechanism is delivered by these leads, which carry electrical signals. The number of leads varies depending on whether the system is unipolar or bipolar. The majority of installations consist of two leads. The leads can also communicate information about the heart to the pacemaker in rare cases. Silicone rubber or polyurethane is used to insulate the pace leads’ entire body. This gives the blood flow considerable strength and a low coefficient of friction. This also assures that the leads will not flex due to heart contractions.
Question: What are the Advantages and Disadvantages of Artificial Cardiac Pacemaker
Advantages of Artificial Cardiac Pacemaker
As a result of the availability of pacemakers, researchers looked at nonheart block causes of syncope.
1. The sick sinus syndrome was treated with pacemakers as soon as a cause and effect relationship appeared to exist. The well-accepted effectiveness of pacing for heart block led to its uncritical application to patients with “pre-heart block” EKG abnormalities and sinus node dysfunction.
2. Treatment of symptomatic complete heart block. Pacemakers are implanted in the majority of patients who have light-headedness spells, or real syncope, but no evidence of heart block or sinus arrest associated with syncope. Many of them have not improved.
3. Treatment of tachyrhythmias. The treatment of tachyrhythmias with overdrive or interruption techniques is an unexpected new use of pacemakers. This represents fewer than 1% of all permanent pacing.
4. With the apparent quick and dramatic success of pacemakers, there has never been a well-controlled study comparing the survival of patients with and without pacemakers.
5. The comparison of prepacing and post pacing groups has historically been used to assess survival advantage. Patients with total heart block and syncopal episodes have a 50% chance of dying within a year, whereas similar patients who are paced have a 70 to 80 percent chance of living for two years.
Complications with a pacemaker (Disadvantages)
The use of a pacemaker might be problematic due to a variety of issues.
Infections at the entrance point of the lead or the subcutaneous region where the pacemaker will be put can cause problems. Pneumothorax and hem thorax, as well as hemorrhage and hematoma at the lead entrance site for temporary pacing or the subcutaneous location for permanent generator implantation, might have serious repercussions. Furthermore, any lead dispositioning can cause problems. Any irritations created by the ventricular walls contribute to the issues that develop from the use of pacemakers.
Breakage of a wire (lead): Metal lead fatigue caused a significant rate of premature system failure, making it the principal limiting factor for the first several years of permanent pacing. The engineering investigation of fracture locations and modes, as well as several design revisions, were required to solve this challenge. Although lead breaks still occur, throughout 6 to 7 years, this problem was reduced to an acceptable level.
Errors in manufacturing: For a variety of reasons, unexpected, sudden failure without prior detection of a rate shift has occurred and continues to occur (lead break, component failure, short circuit, etc. ). This mechanism of failure causes syncope (temporary cessation of circulation) or death in a pacemaker-dependent patient. Sudden unexpected failure is currently unusual (around 1 in 50 to 100 pulse generators), although it happened to 5% or more of pulse generators during the first 10 years of persistent pacing.
Due to the need for a thoracotomy and epicardial electrode implantation, the greatest risk of permanent pacing—operation mortality—was initially estimated to be around 7.5 to 10%. Because of the terrible prognosis of untreated patients and the spectacular relief of successfully paced individuals, this risk was deemed acceptable (see the section below on benefits).
Runaway” pacemakers. “Pacemakers who “run away” Pulse generators can fail at a rapid rate on occasion, but this is rare (up to 800 impulses per minute). This complication proved lethal in several circumstances. Although design advancements have reduced the frequency of this issue, it nevertheless happens.
Electromagnetic interference is a term that describes the phenomenon of electromagnetic interference. Extrinsic noncardiac signals can interfere with pacemaker output signals. The creation of the sensing (“on-demand”) pacemaker, which must sense cardiac signals while rejecting all other electrical signals, exacerbated the situation. This issue (incorrect sensing) still affects about 5% of implanted units.
Issues with a pacemaker’s prevention
The temporary pacemaker should be tested and monitored regularly, and the results should be recorded in the patient’s medical file. The ECG is also closely examined for any signs of pacemaker failure. The V/S heart rate is closely monitored because a malfunction could result in bradycardia in the patient. Pneumothorax signs and symptoms (hypoxia, shortness of breath, pleuritic pain, and hypotension) are kept track of. Dysrhythmias are identified and addressed. To avoid lead dislodgment, it is strongly advised that the patient refrain from or limit physical activity.
Question: When and Who invented the artificial pacemaker?
In 1959, Sweden was the first country to implant a fully implantable cardiac pacemaker. In 1960, three businesses in the United States developed implantable pacemakers. Although animal studies predicted a difficulty with electrodes (increasing excitation threshold), the problem was thought to be controllable, and 5-year pacemaker longevity was widely predicted. Battery capacity and computed discharge rate were used to make the 5-year projection. The first commercially accessible pacemakers were constructed with the pulse generator and leads as one indivisible unit, which meant that the pulse generator could not be replaced without disrupting the electrical connections (leads) to the heart.
Following extensive animal testing, Wilson Greatbatch’s implantable pacemakers were first used in people in April 1960. The primary cells (mercury battery) used by the Greatbatch invention differed from those used by preceding Swedish machines.
How much does a pacemaker cost?
In India, the cost of pacemaker surgery ranges from INR 2.25 lakhs to INR 3 lakhs (USD 3,000 to 4,000). Doctor’s fees, procedure costs (beginning at INR 50,000), pacemaker device costs, and hospital stay are all included in this price.
READ ALSO: TEMPORARY VERSES PERMANENT PACEMAKERS