Cardiac Pacemaker 第三組 電機四王廷暉電機三楊惟喻電機三楊靖平
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1 Cardiac Pacemaker 第三組 電機四王廷暉電機三楊惟喻電機三楊靖平
2 Outline Introduction of cardiac pacemaker Solar-powered cardiac pacemaker Biological cardiac pacemaker
3 Introduction of cardiac pacemaker
4 Cardiac Pacemaker History Perspective Pacemaker Components Indications Battery
5 Historical Perspective Electrical cardiac pacing for the management of brady-arrhythmias was first described in 1952 Permanent transvenous pacing devices were first introduced in the early 1960 s
6 Pacemaker Components Pulse Generator Electronic Circuitry Lead system
7 Pulse Generator Lithium-iodine cell is the current standard battery Advantages: Long life 4 to 10 years Output voltage decreases gradually with time making sudden battery failure unlikely
8 Electronic Circuitry Determines the function of the pacemaker itself Utilizes a standard nomenclature for describing pacemakers
9 Pacemaker Nomenclature I II III IV V Chamber Paced Chamber Sensed Response to Sensing Rate Modulation, Programmability Anti-tachycardia Features A=Atrium A=Atrium T=Triggered P=Simple P=Pacing V=Ventricle V=Ventricle I=Inhibited M=Multi-programmable S=Shock D=Dual D=Dual D=Dual R=Rate Adaptive D=Dual O=None O=None O=None C=Communicating O=None
10 Cardiac Pacemaker Type 心室導線, 固定速率型 (VVI) 心室導線, 可變速率型 (VVIR) 心房導線, 固定速率型 (AAI) 心房導線, 可變速率型 (AAIR) 心房感應心室刺激, 可變速率型 (VDD) 雙房室導線, 固定速率型 (DDD) 雙房室導線, 可變速率型 (DDDR)
11 Lead Systems Endocardial leads which are inserted using a subclavian vein approach Actively fixed to the endocardium using screws or tines Unipolar or bipolar leads
12
13
14 Electrocardiogram During Cardiac Pacing Pacemaker has two main functions: Sense intrinsic cardiac electrical activity Electrically stimulate the heart VVI- senses intrinsic cardiac activity in the ventricle and when a preset interval of time with no ventricular activity occurs it depolarizes the right ventricle causing ventricular contraction
15 Pacer spike
16 Electrocardiogram Dual chamber pacer is more complicated because the pacer has the ability to both sense and pace either the atrium or the ventricle Possible to have only atrial, only ventricular or both atrial and ventricular pacing DDD pacer is a common example of this
17 Atrial Spike Ventricular Spike
18 Indications Symptomatic bradycardia from second degree AV block Bifascicular or trifascicular block with intermittent third degree or type II second degree block Sinus node dysfunction with symptomatic bradycardia
19 Battery Lithium-iodine cell Solar-powered Biological Thermoelectric Generator Body Energy
20 Outline Introduction of cardiac pacemaker Solar-powered cardiac pacemaker Biological cardiac pacemaker
21 Solar-powered cardiac pacemaker
22 Background Powered by battery Cons: limited energy-storing capacity, risk of replacement Powered by intracorporeal energy Cons: low energy output, invasive implantation procedure Powered by solar energy Pros: near-infrared light penetrate the human skin easily, enough energy Cons: direct exposure to sunlight energy storage and management system
23 Experiment 1 Evaluation of different light irradiation intensities Solar module Pig skin flap similar optical property as human Lighting conditions Absolute light intensity Output power outdoor(full sunlight) 842 W/m μw/cm 2 outdoor(in shade) 120 W/m μw/cm 2 indoor 4 W/m 2 4 μw/cm 2
24 Experiment 1
25 Experiment 2 In vivo implantation of the sunlight-powered, batteryless PM Device: Prototype 1: capacitor prototype 2: accumulator
26 Experiment 2 Prototype 2
27 Experiment 2 Right lateral neck
28 Experiment 3 Long-term bench testing of the sunlight-powered, batteryless PM Worst-case scenario: darkness for weeks Animal welfare concern high-power consumption Full charged prototype 2
29 Experiment 3 Safety issue
30 Limitations in humans, garments Long-term effects Standardize conditions
31 Outline Introduction of cardiac pacemaker Solar-powered cardiac pacemaker Biological cardiac pacemaker
32 Biological cardiac pacemaker
33 Idea Implementing may have Infection Children grows rapidly but artificial pacemaker don t
34 Direct conversion of quiescent cardiomyocyte to pacemaker cells by Tbx18 (
35 What is Tbx18? Transcriptional regulators of embryonic SAN development Also Shox2, Tbx3, Tbx5 Becomes undetectable by birth and in adulthood
36 Effectiveness SAN vs. Tbx18 vs. GFP
37 Results Tbx18 induces voltage clock and Ca 2+ mechanisms of automaticity Tbx18 converts myocyte morphology to that of SAN cells The isan phenotype persists beyond Tbx18 expression
38 Persistency
39 Summary 目前還停留在實驗階段 ( 天竺鼠 ) 最初是設計成短期的療程, 但經過實驗後發現, 或許可以研發成為長期穩定產品 最小的心律調節器
40 Reference
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