Download - Pacing the Heart Ayo Ositelu ECE 5030 Final Presentation Tuesday, 15 December 2009 @ 1:00pm
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Pacing the Heart
Ayo OsiteluECE 5030 Final Presentation
Tuesday, 15 December 2009 @ 1:00pm
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Outline
• Background
• Main Features
• New Features
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The Cardiac Action Potential
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 7.
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Natural Pacemakers of the Heart
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 8.
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Two Schools of Thought
• Current density theory• “The critical factor
required to induce a regenerative wave front of depolarization is the magnitude of current flowing through a given mass of myocardium…”
• Electric Field Theory• “The critical factor
affecting myocardial depolarization is the magnitude of the electric field that is induced in the myocardium…”
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History
Hyman’s Pacemaker of 1932 Accompanying Flow Diagram
http://www.hrsonline.org/News/ep-history/topics-in-depth/hymanspacemaker2.cfm
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Components
• Pacemaker Leads
• Pulse Generator
• Power Source (not discussed)
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Pacemaker Leads
• “The leads are the only link between the sophisticated electronics in the pulse generator and the heart.”
• Relevant Issues: Polarization, electrode porosity, electrode composition, the electrode-tissue interface, etc.
Clinical Cardiac Pacing, pg 70.http://www.hrsonline.org/News/ep...
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Pacemaker Leads
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 74, 75.
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Pacemaker Leads
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 86.
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Pulse Generator
• Pacing therapy controller
• Output amplifiers
• Sense amplifiers
• Diagnostic subsystem
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Pulse Generator
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 113, 114.
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New Features
• Sensing
• Telemetry
• Improved SNR
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Rate-Adaptive Sensors
• Activity-Sensing Rate-Adaptive Sensors• Rate-Modulated Pacing Controlled by Mixed
Venous Oxygen Saturation• Temperature-Controlled Rate-Adaptive Pacing• Rate-Adaptive Pacing Controlled by Dynamic
Right Ventricular Pressure (dP/dtmax)• Rate-Adaptive Pacing Based on Impedance-
Derived Minute Ventilation, etc.
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Rate-Adaptive Sensors
Kristensson, et al.
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Activity-Sensing Sensors
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 168, 169.
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Activity-Sensing Sensors
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 171.
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Activity-Sensing Sensors
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 171.
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Activity-Sensing Sensors
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 171.
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Rate-Adaptive Venous Oxygen Sensor
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 188.
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Rate-Adaptive Venous Oxygen Sensor
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 192.
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Rate-Adaptive Venous Oxygen Sensor
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 192.
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Temperature-Controlled Sensor
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 202.
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Temperature-Controlled Sensor
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 203.
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Temperature-Controlled Sensor
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 203.
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Temperature-Controlled Sensor
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 206.
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Temperature-Controlled Sensor
Fearnot, et al.
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Manufacturer Overview
• Biotec, S.P.A., Bologna, Italy• Biotronik, GmbH & Co., Berlin, Germany• Cardiac Pacemakers Inc., St. Paul, MN• Cook Pacemakers Corporation, Leechburg, PA• Ela Medical, Rougermont, France• Intermedics Inc., Angleton, TX• Medtronic Inc., Minneapolis, MN
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Manufacturer Overview
• Siemens Ltd., Solna, Sweden• Sorin Biomedica, Saluggia, Italy• St. Jude Medical, Inc, St. Paul, MN• Telectronics Pacing Systems, Englewwod, CO• Vitatron Medical B.V., Dieren, The
Netherlands.
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Manufacturer Overview
Ellenbogen, Kay, and Wilkoff. Clinical Cardiac Pacing, pg 144.
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Telemetry
• “Telemetry involves the transmission of information from the pulse generator to an external programmer.”
• Battery voltage and impedance, stimulus current, voltage, and energy, lead resistance, intracardiac electrograms, and stored histograms of pace and sensed data retrievable from telemetry
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Telemetry
Medtronic CareLink® Network Monitoring Device
Biotronik Home Monitoring®
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Improving SNR
• Federica Censi, et al. studying the effects of electromagnetic interference on pacemakers.
• RF feedthrough filters
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References• Ellenbogen KA, Kay GN, Wilkoff BL. Clincial Cardiac Pacing. W.B. Saunders Company. Philadelphia. 2005. pg 3—276.• Fearnot, NE et al. Heart Rate Correlation, response time, and effect of previous exercise using advanced pacing rate
algorithm for temperature-based rate modulation. PACE (11): 1846-1852, 1988.• Kristensson B, et al. Holter-monitored heart rhythm during atrioventricular synchronous and fixed-rate Ventricular pacing.
PACE (9): 511, 1986.• Censi, F, et al. Interference between mobile phones and pacemakers: a look inside. Ann Ist Super Sanita, 2007. Vol. 43, 3:
254—259.• Hayes, DL and Vliestra RE. Pacemaker Malfunction. Ann Internal Medicine. 1993; 119: 828—835.