CARDIAC PACEMAKERS..

What is a PACEMAKER..??
The contraction of heart muscle in all animals with hearts is initiated by chemical impulses. The rate at which these impulses fire controls the heart rate. The cells that create these rhythmical impulses are called pacemaker cells, and they directly control the heart rate.

Where is a PACEMAKER located..??

The pacemaker is located in the wall of the right atrium.

Primary (SA node)

The sinoatrial node (SA node) is a group of cells positioned on the wall of the right atrium, near the entrance of the superior vena cava. These cells are modified cardiomyocyte. The cells in this node possess the ability of producing electrical impulses.

Secondary (AV junction and Bundle of His)

If the SA node does not function, a group of cells further down the heart will become the heart's pacemaker, this is known as an ectopic pacemaker. These cells form the atrioventricular node (AV node), which is an area between the left atria and the right ventricles, within the atrial septum. These are called the secondary pacemaker.

Generation of Action Potentials..

There are three main stages in the generation of an action potential in a pacemaker cell. There is no phase one or two, just phases zero, three and four. The key to the rhythmic firing of pacemaker cells is that, unlike muscle and neurons, these cells will slowly depolarize by themselves.

Phase 4 - Pacemaker potential Phase 0 - Upstroke Phase-3 Repolarization

For the heart to beat properly, the signal must travel down a specific path to reach the ventricles, the heart's lower (pumping) chambers. The natural pacemaker may be defective, causing the heartbeat to be too fast,too slow or irregular. The heart's electrical pathways also may be blocked. Hence , after a period, artificial pacemakers are used.

What is an ARTIFICIAL PACEMAKER..??

Cardiac pacemakers are generally used to manage a slow or irregular heart rate. The pacemaker system applies precisely timed electrical signals to induce heart muscle contraction and cause the heart to beat in a manner very similar to a naturally occurring heart rhythm

Components of an Artificial Pacemaker..

Pulse Generator At Least One Electrode One Or Two Pacing Leads Connecting The Pacemaker To The Heart

Where is it placed..??
It is usually implanted between the skin and pectoral muscle. The sealed lithium iodine battery provides electrical energy to the pacemaker. This battery replaced the mercury-zinc battery in 1975, extending the life of some pacemaker models by over 10 yr.The circuitry converts the electrical energy to small electrical signals.

Block Diagram Of A Pacemaker..

Recent Trends in Pacemakers..

Nuclear powered pacemakers

Various Power Sources Have Been Used For Pacemakers, Including A Radioactive Material Called Plutonium-238. There Are Still A Number Of People In The U.S. Who Have Nuclear Powered Pacemakers, Which Need To Be Disposed Of Properly Upon Removal.

Battery-free pacemakers
Now there are so many researches going under this topic and there are evolving methods. One such method is combining the implanted device with a microgenerator producing electricity every time the patient moves, effectively eliminating the need for an internal battery.

Wireless Pacemakers
These are the pacemakers that communicate wirelessly with a monitoring service, which is in turn accessed daily by the doctor.The device can be reprogrammed using wireless signals.This method reduces the no of surgeries that the patient has to undergo.

Laser Pacemakers
Biomedical engineers have used a laser beam with a 1.875-micrometer wavelength to force the quail embryo's heartbeat to speed up, The engineers also hope that this work might one day lead to an optical pacemaker for humans, but several obstacles remain.

SMS-capable pacemakers

The latest application is an SMS-enabled pacemaker that can automatically send messages to a cardiologist's cellphone, allowing the doctor to monitor a patient's condition. The unit was developed by Dutch manufacturer Biotronik, and the first implant was performed at VU University Medical Center in Amsterdam.

Lead-Less Pacemakers
This is a kind of pacemaker which can be implanted directly into our heart via catheter and permanently latch itself into flesh with tiny claws. Then, doctors can wirelessly monitor and even control the device from a nearby phone.