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ASSIST DEVICES AND BIO - TELEMETRY
ASSIST DEVICES AND BIO-TELEMETRY
EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College
ASSIST DEVICES AND BIO - TELEMETRY
ASSIST DEVICES AND BIO-TELEMETRY
Cardiac pacemakers, DC Defibrillator, Telemetry principles, frequency selection, Bio-telemetry, radio-pill and tele-stimulation.
Biotelemetry is “the measurement of biological parameters over longer distance”. The means of transmitting the data from the point of generation to the point of reception can take any forms. Perhaps the simplest application of the principle of biotelemetry is the stethoscope, whereby heart beat sounds are amplified acoustically and transmitted through a hollow tube to be picked up by the ear of the physician for interpretation.
Applications of Bio-Telemetry:
In many situations, it becomes necessary to monitor physiological events from a distance. To quote a few applications are, 1. Radio frequency transmissions for monitoring the health of astronauts in space. 2. Patient monitoring in an ambulance and in other locations away from the hospital. 3. Collection of medical data from home or office. 4. Patient monitoring, where freedom of movement is desired, such as in obtaining an exercise ECG. (In this instance, the requirement of trailing wires is cumbersome and dangerous). 5. Research on unrestrained and unanesthetized animals in their natural habitat. 6. Use of telephone links for the transmission of ECGs or other medical data. 7. Special internal techniques, such as measuring pH or pressure in the gastrointestinal tract. 8. Isolation of an electrically susceptible patient from power-line operated ECG equipment, to protect him from accidental shock.
EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College
ASSIST DEVICES AND BIO - TELEMETRY
Principles of Design of Bio-Telemetry System:
1. The telemetry system should be selected to transmit the bio-electric signal with maximum fidelity and simplicity. 2. System should not affect living system by interference. 3. It should have more stability and reliability. 4. The power consumption at the transmitter and the receiver should be small to extend the source lifetime in the case of implanted units. 5. The size and weight of the telemetry system should be compact. 6. For wire transmission, the shielding of cable is a must to reduce noise levels. At the transmitter side, the amplifiers should be differential amplifiers to reject common mode interference. 7. Miniaturization of the radio telemetering system helps to reduce noise.
Physiological parameters adaptable to biotelemetry
Based on the hardware systems, measurements can be applied to two categories: 1. Bioelectrical Parameters, such as ECG, EEG and EMG. 2. Physiological variables that require transducers such as blood pressure, gastrointestinal pressure, blood flow and temperatures.
Bioelectric Parameters: (such as ECG, EMG and EEG) The signal is obtained directly in electrical form. One example is ECG telemetry - the transmission of ECGs from an ambulance or site of emergency to a hospital. A cardiologist at the hospital can immediately interpret the ECG, instruct the trained rescue team in their emergency resuscitation procedures and arrange for any special treatment that may be necessary upon the patient’s arrival at the hospital. In this application, the telemetry to the hospital is supplemented by two-way voice communication. Telemetry of EEG signals has also been used in studies of mentally disturbed children. The child wears a specially designed “spaceman’s EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College 3
ASSIST DEVICES AND BIO - TELEMETRY
helmet” with built-in electrodes, so that the EEG can be monitored without traumatic difficulties during play. In some clinic, the children are left to play with other children in a normal nursery school environment. They are monitored continuously while data are recorded. Telemetry of EMG signals is useful for studies of muscle damage, partial paralysis problems.
Physiological variables: The physiological parameters are measured as a variation of resistance, capacitance or inductance. The differential signal obtained from these variations can be calibrated to represent pressure flow, temperature and so on. In the field of blood pressure and heart rate research in
unanesthetized animals, the transducers are surgically implanted with leads brought out through the animal’s skin. A male plug is attached postoperatively and later connected to the female socket contained in the transmitter unit. The use of thermistors to measure temperature is also easily adaptable to telemetry. In addition to the continuous monitoring of skin temperature or systemic body temperature, the thermistor system has been found to be used in obstetrics and gynecology. One more application is the use of “radio pill” to monitor stomach pressure of pH. In this application, a pill that contains a sensor plus miniature transmitter is swallowed and the data are picked up by a remote receiver and recorded.
Advantages of Biotelemetry:
1. Major advantage of using biotelemetry is removing the cables from patient and providing a more comfortable medium to patient. Patient needs to carry only a small transmitter. 2. Isolation of patient from high voltage completely. Transmitters in the patient side work with batteries without any danger of electrical shock.
EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College
College 5 . The receiver demodulates the frequency modulation signal to recover ECG waveform. The receiver station is equipped with a bank of radio receivers tuned to the same frequency as the transmitters. (Electrical Interference of 50Hz). 4. Most transmitters contain an analog ECG section that acquires the signal and uses it to modulate the frequency of the radio transmitters. Long 3. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Classification of Telemetry Systems: Telemetry Systems are classified as. Based on data transmitted a. Short b. The telemetry unit uses tiny VHF or UHF radio transmitter that is attached to the patient either by a clip or a small sack is hung around the patient’s neck. Analog b. ASSIST DEVICES AND BIO . The waveform is then displayed on an oscilloscope or strip chart recorder as in other patient monitoring systems. Continuous monitoring of the patient can be obtained. These units are sometimes called as post coronary care units (PCCU) or step down CCU. Based on transmission distance a.UNIT III 3. Digital 2. 1. Based on whether user as control over transmission channel or not.TELEMETRY Battery operated amplifiers and transmitters will cause no additional noise as long as no connection with line voltage at patient side. Radio Telemetry systems: Many hospitals use radio telemetry systems to monitor certain patients. The most common use of radio telemetry is to keep track of improving cardiac patients and at the same time keep them ambulatory.
The transmission line connects the signal input blocks to the read-out device by wire or wireless means. Elements of Biotelemetry Systems: The essential blocks of a biotelemetry system are shown in Figure below. Where as the final modulator is practically always an FM system. The principle of double modulation gives better interference free performance in transmission and enables the reception of low frequency biological signals.UNIT III ASSIST DEVICES AND BIO . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College 6 . The transducer converts the biological variable into an electrical signa1. The signal conditioner amplifies and modifies this signal for effective transmission. The sub-modulator can be a FM system or a PWM system. This means that comparatively lower signal frequency carrier is employed in addition to the VHF which finally transmits the signal from the transmitter.TELEMETRY Modulation systems: The modulation system used in wireless telemetry for transmitting biomedical signals makes use of two modulators.
a miniature battery operated radio transmitter is connected to the electrodes of the patient. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. FM transmission is often used for telemetry. The stages of a typical biotelemetry system can be broken down into functional blocks as shown in figure below for the transmitter and the receiver. Later the processed signal is transmitted using radio transmitter. Either amplitude modulation or frequency modulation can be used but due to reduced interference. The signal is then passed through a stage of conditioning circuit where amplification and processing is done. This transmitter broadcasts the biopotential to a remotely located receiver. The radio frequency used in this system varies from few hundred KHZ to 300 MHZ.TELEMETRY Single Channel Telemetry system: A Single Channel Telemetry system is as shown in the figure below. Physiological signals are obtained from the subject by means of appropriate transducers. For a single channel system. The receiver detects the radio signals and recovers the signals for further processing. College 7 .UNIT III ASSIST DEVICES AND BIO .
the subcarrier system is needed. College 8 .TELEMETRY Radio Telemetry with a subcarrier: When the relative position of transmitter to the body or other conduction object changes. Otherwise the real signal will be distorted by the loading effect. Since the sub carrier frequency is quite different form all noise interference and loading effect. So one additional stage of demodulation is needed to convert the signal from the modulated subcarrier back to its real frequency and amplitude. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. At the end. it can be separated by filters. the carrier frequency and amplitude will change. The signal is modulated on a subcarrier to convert the signal frequency to the neighbourhood of the subcarrier frequency.F and recovers the subcarrier carrying the signal.UNIT III ASSIST DEVICES AND BIO . Then the R. they can be separated by filters.F carrier is modulated by this sub carrier carrying the signal. This effect is not distinguishable from the signal at the receiver end. This is due to the loading change of the carrier frequency resonant circuit. To avoid this loading effect. If the signal has a frequency different from the loading effect. the receiver detects the R.
Frequency division multiplexing 2. modulated subcarriers will be separated by the proper band pass filters after the first discrimination (demodulation). it is desirable to have simultaneous recordings of several signals for correlation study. College 9 . At that time.F. the simultaneous operation of the several single channel units is difficult. There are two types: 1. carrier. Time division multiplexing Frequency division multiplex System: Each bio-signal is frequency modulated on a subcarrier frequency. At the receiver side.UNIT III ASSIST DEVICES AND BIO . Then these modulated subcarrier frequencies are combined to modulate the main R. When the number of channels is more than two or three. Each signal requires a telemetry channel. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. multiple channel (multiplex) telemetry system adopted.TELEMETRY Multiple Channel telemetry Systems: For most bio-medical experiments. Later the individual signals are recovered from these modulated subcarriers by the second set of discriminators (Demodulators).
the signal in each channel at the receiver side can be recovered without noticeable distortion. so. If the number of scanning cycles per second is large and if the transmitter and the receiver are synchronized. Time division multiplex System: Most of the biomedical signals have low frequency bandwidth requirements. the process is reversed. Then the transmitter is switched to the next signal channel in a definite sequence. If Tn = 1/ fn = scanning period. the operation is repeated from the first channel. At the receiver end. Practically the number of channels allowed is smaller than the calculated value of ‘n' to avoid interference between channels. time division multiplex system can be used by the time sharing basis.e) fn > 2fsmax 2. When all the channels have been scanned. signal pulses are distributed to the individual channels by a synchronized switching circuit. Conditions: 1. The sequentially arranged. and tn is the sampling time of each channel. (i.UNIT III ASSIST DEVICES AND BIO . then the maximum number of channels that can be obtained is n = Tn/tn. The transmission channel is connected to each signal-channel input for a short time to sample and transmit that signal. The low pass filters are used to extract the signals without any noise. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The scanning frequency fn should be at least greater than twice the maximum signal frequency fs.TELEMETRY The frequency of the subcarriers has to be carefully selected to avoid interference. College 10 .
After completing its mission it will come out of the human body by normal bowel movement. The pill is 10mm in diameter and 30mm long weighing around 5gm and records parameters like temperature. College 11 .UNIT III ASSIST DEVICES AND BIO . sensors. application. The pill comprises an outer biocompatible capsule encasing micro sensors. The pill houses a PCB chip carrier that acts as a common platform for attachment of.TELEMETRY Radio pill: Radio pill when swallowed. which is biocompatible. 3. will travel the GI tract (Gastrointestinal tract) and simultaneously perform multiparameter in physiological analysis.specific integrated circuit (ASIC). conductivity and dissolved oxygen in real time. radio transmitter and two silver-oxide cells. 2. It is made up of two halves. which are joined together by screwing. 1. pH. a control chip. radio transmitter and EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The outer casing of the pill is made by machining chemically resistant polyetheterketone. INSIDE THE CAPSULE: The schematic diagram of the microelectronic pill is as shown in figure below.
a silicon diode. the activity of fermenting bacteria. College 12 . bile secretion and the breakdown of organic components into charged colloids.TELEMETRY Task of the sensors: The device is provided with four micro sensors. inflammatory bowel disease. batteries. a pair of direct. The conductivity sensor is used to monitor the contents of the GI tract by measuring water and salt absorption. hypertension. particularly associated with pancreatic disease.UNIT III 4. It is used to determine the presence of pathological conditions associated with abnormal pH levels. namely 1. ISFET: 1. the level of acid excretion. an ion-selective field effect transistor (ISFET). ASSIST DEVICES AND BIO .-contact gold electrodes and 4. It is used to measure pH. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Gold electrodes: A pair of direct contact gold electrode is used to measure conductivity. 2. reflux to the oesophagus and the effect of GI-specific drugs on target organs. 3. Silicon diode: The silicon diode is used to measure the body core temperature and also identify local changes associated with tissue inflammation and ulcers. 2. a 3-electrode electrochemical cell.
The batteries are connected in series and provide an operating time of 40 hours at the rated power consumption of 12. The 3mm diameter access channel in the center of each steel clamp exposes the sensing region of the chips to the ambient environment. measuring 4.) glucose and lactate sensing. The implementation of a generic oxygen sensor will also enable the development of a first generation enzyme linked amperometric biosensors.electrode electrochemical cell: The 3-electrode electrochemical cell is used to detect the level of dissolved oxygen in solution.5mm pitch polyimide ribbon connector. thus extending the range of future applications to include (eg. The microelectronic sensors are attached to the PCB chip carrier by a 10 pin.75 x 5mm2. College 13 . The sensor chips are provided at the front end of the pill and are exposed to the ambient environment through access ports. The PCB carrier is made from 1. The transmitter and the ASIC are also integrated on the board. The unit is powered by two standard 1. as well as immunosensing protocols. The oxygen sensor measures the oxygen gradient from the proximal to the distal GI tract. This enables a variety of syndromes to be investigated including the growth of aerobic bacteria or bacterial infection. comprises the silicon diode temperature sensor.55V silver-oxide cells with a capacity of 175mAh.UNIT III ASSIST DEVICES AND BIO .1mW.TELEMETRY 3. the pH ISFET sensor and the two-electrode 5x 10-4mm2 EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. They are scaled by two sets of stainless-steel clamps incorporating an o. 0. The integrated radio transmitter sends the signal to a local receiver prior to data acquition on a computer.8µm thick sheet of fluoroelastomer seal. The sensors are fabricated on two silicon chips located at the front end of the capsule. SENSORS: The schematic diagram of sensor chips is as shown below.6mm thick fiberglass board. Chip1.
It promotes electrode polarization and reduces response time by enhancing transport to the electrode surface. a microelectrode array of 57x10µm diameter working gold electrodes and an integrated 1. a 500µm diameter and 10-nL electrolyte chamber and 15x600µm floating gate of the ISFET sensor. College 14 . The 3-electrode electrochemical cell of the oxygen sensor comprises the 1x10-1 mm2 counter electrode made of gold. The oxygen sensor is embedded in the electrolyte chamber. Predefined n-channels in the p-type bulk silicon form the basis for the diode and the ISFET. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.5x 10-3mm2.TELEMETRY conductivity sensor. comprises the electrochemical oxygen sensor and a NiCr resistance thermometer.5x 10-2mm2 Ag/Agcl reference electrode. The pH sensor consists of the integrated 3x 10-2mm2 Ag/Agcl reference electrode.UNIT III ASSIST DEVICES AND BIO . The microelectrode array has an inter-electrode spacing of 25µm and a combined area of 4. The 15x600µm floating gate of the ISFET is precovered with a 50nm thick proton-sensitive layer of Si3N4 for pH detection. Chip2. measuring 5 x 5mm2.
The 500nm thick layer of thermally evaporated silver is used to fabricate the reference electrode. The conductivity circuit operates at direct current. It contains an analogue signal conditioning module operating the sensors. An oscillator provides the clock signal. 10-bit ADC and DAC converters and a digital data processing module.UNIT III ASSIST DEVICES AND BIO .TELEMETRY The NiCr resistance thermometer is made from a 100nm thick layer of NiCr and is 5µm wide and 11mm long. Control chip: The ASIC is the control unit that connects together other components of the microsystem as shown in the figure below. It is then oxidized to Ag/Agcl by chronopotentiometry. The temperature circuitry biases the diode at constant current so a change in temperature reflects a corresponding change in diode voltage. measuring the resistance across the electrode pair as an inverse function of solution conductivity. An incorporated potentiostat circuit operates the amperometric EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The pH ISFET sensor is biased as a simple source and drain follower at constant current with the drain-source voltage changing with the threshold voltage and pH. College 15 .
2msec.1V supply. Conductivity from 0. 1. The digital data processing module processes the digitized signals through the use of a serial bit stream data compression algorithm. Temperature from 0 to 70°C. which provide an operating time of more than 40 hours of the microsystem. 4. Range of measurement: The microsystem can measure. The ASIC and sensor consume 5.1mW and current consumption is around 3. 2.8V with the resolution determined by the ADC. The bandwidth for each channel is limited by the sampling interval of 0. These are sequenced through a multiplexer prior of being digitized by the ADC.TELEMETRY oxygen sensor with a 10-bit DAC controlling the working electrode potential with respect to the reference. pH from 1 to 13. The digital module is clocked at 32KHz and employs a sleep mode to conserve power from the analogue module. The analogue signals have a full-scale dynamic range of 2.2mA of current.cm-1( s=siemens).9mA at 3. which decides when transmission is required by comparing the most recent sample with the previous sampled data.7mA of current and the free running radio transmitter consumes 6.01 MHz at 20°C generating a signal of 10KHz bandwidth.2mg/litre. The transmitter is designed to operate at a transmission frequency of 40. Radio transmitter: The size of the transmitter is 8x5x3mm. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.3mW corresponding to 1.UNIT III ASSIST DEVICES AND BIO . The power consumption of the system is around 12. Power consumption: Two SR44 Ag2O batteries are used.8mW at 2. The transmission range is one meter and the modulation scheme frequency shift keying has a data rate of 1 kbps. College 16 . 3.05 to 10 ms. Dissolved oxygen up to 8.
Here large spoon shaped electrodes with insulated handle are used. The instrument for administering the electric shock is called as defibrillator. Sometimes electrodes in the form of fine wires of Teflon coated stainless steel are used. Defibrillator types: There are two types of defibrillators based on the electrodes placement. the contact impedance is about 50 ohms. Since the electrode comes in direct contact with the heart. Ventricular fibrillation is dangerous when compared to arterial fibrillation. If the heart does not recover spontaneously after delivering the shock to the heart using defibrillator then a pacemaker may be employed to restart the rhythmic contraction of the myocardium.UNIT III ASSIST DEVICES AND BIO . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. There are AC and DC defibrillator methods but DC defibrillator is used today.TELEMETRY Defibrillators Introduction: Defibrillator is an electronic device that creates a sustained myocardial depolarization of a patient’s heart in order to stop ventricular fibrillation or arterial fibrillation. after that normal heart action may resume. College 17 . a) Internal defibrillator (Surgical Type) b) External defibrillator (Therapeutic Type) Internal defibrillator: It is used when chest is opened. Defibrillation is the application of electric shock to the area of the heart which makes all the heart muscle fibers enter their refractory period together.
The spoon shaped electrode is as shown below.5 to 5 milliseconds. the heart requires excitation energy of about 15 to 50 J. the heart requires excitation energy of about 50 to 400 J.TELEMETRY In internal defibrillation. External defibrillator: It is used on the chest. Here paddle shaped electrodes are used.UNIT III ASSIST DEVICES AND BIO . College 18 . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The duration of the shock is about 1 to 5 milliseconds. Since the electrodes are placed above the chest. There are AC and DC defibrillator methods but DC defibrillator is used today. The paddle shaped electrode is as shown below. the contact impedance on the chest is about 100 ohms even after applying the gel. In external defibrillation. The duration of the shock is about 2. The bottom of the electrode consists of a copper disc with 3 to 5 cm diameter for pediatric patient and 8 to 10 cm diameter for adult patients with a highly insulated handle.
The sensation produced by the fibrillating atria and irregular ventricular action can be quite traumatic for the patient. DC defibrillator 3. Hence. Biphasic DC defibrillator 1. Double square pulse DC defibrillator 6. 1. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College 19 . resuscitative measures must be applied within 5 minutes or less after the attack or irreversible brain damage and death will occur. Types of defibrillator based on operation or Voltage delivered: There are six types of defibrillators based on the nature of the output voltage delivered. The atria or the ventricles are unable to respond completely and effectively to each stimulus. Under conditions of atrial fibrillation. the ventricles can still function normally but they respond with irregular rhythms to the non-synchronized bombardment of electrical stimulation from the fibrillating atria and the circulation is still maintained although not as efficiently. the most successful method of defibrillation is the application of electric shock to the area of the heart which makes all the heart muscle fibres enter their refractory period together after which normal heart action may resume. Ventricular fibrillation is dangerous when the ventricles are unable to pump the blood. One of the earliest forms of an electrical defibrillator is the AC defibrillator. AC defibrillator: Although mechanical methods like chest massage for defibrillation have been tried for years. which applies several cycles of alternating current to the heart from the power line through a step-up transformer. They are. AC defibrillator 2.UNIT III ASSIST DEVICES AND BIO . Synchronized DC defibrillator 4. Square pulse DC defibrillator 5.TELEMETRY Mechanism: Fibrillation results from a rapid discharge of impulses from a single or multiple foci in the atria or in the ventricles.
EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 2.UNIT III ASSIST DEVICES AND BIO . The 220V AC main supply is connected to a variable autotransformer in the primary circuit. 2. AC defibrillator cannot be successfully used to correct atrial fibrillation. 3. There are many disadvantages in using AC defibrillators. The output of the autotransformer is fed as input to a step-up transformer to produce high voltage with a rms value of about 8000 V. When external electrodes are used on the chest. voltages of twice the value are required. Successive attempts to correct ventricular fibrillation are often required. voltage ranging from 80 to 300V rms is required. Capacitive Discharge DC Defibrillators The Capacitive Discharge type DC Defibrillator is as shown in the figure below. Disadvantages: 1. College 20 .TELEMETRY To achieve defibrillation with internal electrodes placed on the surface of the heart (in open heart surgery). The transformer must be capable of supplying 4 to 6 amperes current during the stimulus period.
The voltage to which C is charged is determined by the autotransformer in the primary circuit. which means that the time constant must be less than 2 s. College 21 . An AC voltmeter across the primary is calibrated to indicate the energy stored in the capacitor. undesirable current spike that would occur at the beginning of the discharge. The inductor is used to shape the wave in order to eliminate a sharp. The capacitor is discharged through the electrodes and the patient's torso represented by a resistive load. limits the charging current to protect the components. and the inductor L. With the electrodes firmly placed at appropriate positions on the chest. The area under the curve is proportional to the energy delivered. which charges the capacitor C.UNIT III ASSIST DEVICES AND BIO . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Rs. the clinician or technician discharges the capacitor by momentarily changing the switch S from position 1 to position 2. The wave is monophasic and the peak value of the current is nearly 20 A. The energy delivered to the patient is represented by the typical waveform shown in figure above. Five times the RC time constant circuit is required to reach 99% of a full charge-a value it should reach in 10 seconds.TELEMETRY A half-wave rectifier rectifies this high AC voltage to obtain DC voltage. A series resistance.
depending on the size of the capacitor. Capacitors used in the defibrillator range from 10 to 50 F. Thus. the switch automatically returns to position 1 and the process can be repeated. The circuit diagram of such a system is shown in figure below. Once the discharge is completed. as shown in figure below. the amount of electrical energy discharged by the capacitor may range between 100 and 400 watts or joules when the electrodes are applied externally and the duration of the effective portion of the discharge is approximately 5 m/s. C is the capacitance and V is the voltage to which the capacitor is charged. because peak voltages as high as 6000 V may be used. To reduce this risk. College 22 . Delay-Line Capacitive Discharge DC Defibrillator Even with DC defibrillation.UNIT III ASSIST DEVICES AND BIO . the voltage for a maximum of 400 J ranges from 2 to 9 KV. The parallel combination of C1 and C2 stores the same energy as the single capacitor in the above figure. The energy stored in the capacitor is given by the equation W= 1 CV2 2 Where. about 50 to 100 joules only is required for defibrillation.TELEMETRY Depending on the defibrillator energy setting. But its discharge characteristic is more rectangular in shape (1onger duration of approximately 10 m/s) at a much lower voltage. When the electrodes are applied directly to the heart. if necessary. there is a danger of damage to the myocardium and the chest walls. some defibrillators produce dual-peak waveforms of longer duration (approximately 10 m/s) at a much lower voltage. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.
It includes diagnostic circuitry which is used to assess the fibrillation before delivering the defibrillation pulse and synchroniser circuitry which is used to deliver the defibrillation pulse at the correct time. So. The pacemaker is used in the case of emergency as a temporary pacing. If the counter shock falls in the U wave segment then atrial fibrillation is produced. T wave and U wave segments. College 23 . There must be proper diagnosis for ventricular fibrillation. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. it could induce fibrillations in a normal heart. as to eliminate the ventricular fibrillation or atrial fibrillation without inducing them. effective defibrillation can be achieved in adults with lower levels of delivered energy . electrocardioscope and pacemaker is as shown in the figure below. 3.between 50 and 200 watts. atrial fibrillation and other arrhythmias it is essential to defibrillator with synchronizer circuit. DC defibrillator circuit consisting of defibrillator. Simple DC defibrillator can arrest the ventricular fibrillation.UNIT III ASSIST DEVICES AND BIO .TELEMETRY With this type of waveform. If the counter shock falls in the T segment then the ventricular fibrillation is developed. But for termination of ventricular tachycardia. There are two vulnerable zones in a normal cardiac cycle. Synchronised DC defibrillator: Defibrillation is a risky procedure since if it is applied incorrectly.
The switch is placed in the defibrillator mode if ventricular fibrillation is suspected. 5. This is provided by the AND gate 'C'. Meanwhile the medical attendant energizes the switch to deliver a defibrillation pulse. College 24 . 2. A defibrillator pulse is delivered only if the fibrillation detector produces an output at the same time that the attendant energizes the switch. 7. The QRS detector in that mode consists of a threshold circuit that would pass a signal as output if R wave is absent in the electrocardiogram. 4. The electrocardiogram is obtained by means of an ECG unit. If they are present. connected to the patient who is going to receive defibrillation pulse. provided the signal from the medical attendant is also present at one of the two inputs of that AND gate. At the two inputs of AND gate 'B' if any one of the inputs is missing. 3. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The AND gate 'B' delivers on signal to the defibrillator only when the ‘R’ wave is absent. then it would not give any output.TELEMETRY Working: 1. 6. fibrillation is probable and the fibrillation detector gives an output signal. The fibrillation detector searches the ECG signal for frequency components above 150 Hz.UNIT III ASSIST DEVICES AND BIO . By this way the defibrillator is inhibited and would not deliver the defibrillation pulse. Other it would not give any output if R Wave is present.
TELEMETRY Thus when the AND gate B and AND gate C are simultaneously triggering the defibrillator.UNIT III 8. The output can be controlled by varying the voltage on the capacitor or duration of discharge. Digital circuits can also produce a square pulse used for defibrillation. 9. the ventricles will be in uniform state of depolarisation and the normal heart beat will not be disturbed. When sufficient energy has been delivered to the subject a shunt SCR short circuits the capacitor and terminates the pulse. Its output is used to time the delivery of the defibrillation pulse with a delay of 30 milliseconds. In the synchronization mode. At this time. College 25 . the defibrillation pulse is delivered. Square wave defibrillator: In this defibrillator. First the doctor diagnoses it correctly and then the treatment is initiated using this circuit. 4. the defibrillator is synchronised with the ECG unit. capacitor is discharged through the subject by turning on a series silicon controlled rectifier (SCR). This delay of 30 milliseconds after the occurrence of R wave allows the attendant to defibrillate atrium without inducing ventricular fibrillation. 10. Here the defibrillation is obtained at low peak current and so there is no side effect. ASSIST DEVICES AND BIO . Suppose a patient is suffered by atrial fibrillation. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The ECG signal in the instrument is given to QRS detector.
2EEL (Or) ET = EDL + 2EEL + ET RT EC 2 R E + RT + R D Thus the energy delivered to the thorax. ET = ID2RTTD = 2 RT EP 2 R E + RT From the above equation we can know that the energy in the pulse is not delivered completely to thorax. VD and ID are the instantaneous voltage and current available from the defibrillator pulse respectively and TD is the duration of the pulse. EEL = ID2RETD Energy delivered to the thorax.TD = ID2 (2RE + RT)TD EP = 2 R E + RT The energy loss in the defibrillator EDL = ID2RDTD The energy loss in each electrode and skin.TELEMETRY Analysis In the figure above. R = RD + 2RE + RT Further. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.UNIT III ASSIST DEVICES AND BIO . College 26 .skin resistance and RT is the thorax resistance. RE is the electrode . Similarly the energy delivered to the thorax can be expressed in the form of available energy from the capacitor discharge in the case of DC defibrillator whose output is assumed to a square pulse. EC = ID2RTD = ∴ ET = EC . The Energy in the pulse is. Total circuit resistance. Energy available from the capacitor.EDL . the energy in the pulse can also be written in terms of voltage and resistance between the cable attached to the patient such that VD . ET is diminised from the available energy due to effects of resistance of defibrillator and electrode-skin resistance. EP = VDIDTD Where. Ro is the internal resistance of the defibrillator.
5. some of the fibrillating cells will be excitable and will be depolarised. It requires no inductor 3. If the chest is opened. It requires low peak current 2. 1. The timing of the second pulse should be such that those cells which were refractory to the first pulse are now become excitable. Double Square Pulse Defibrillator: Double square pulse defibrillator is normally used after the open heart surgery. Conventional DC and AC defibrillators are producing myocardial injury with a diminished ventricular function for a period of approximately 30 minutes following the delivery of shock. only lower energy electric shock should be given. The pulse amplitude and width together with the interval should be such that the cells defibrillated by the first pulse will be refractory to the second pulse. Instead of 800 – 1500V. It is possible to use physically smaller electrolytic capacitors. Here 8-60 V double pulse is applied with a mean energy of 2. When the first pulse is delivered.TELEMETRY Advantages: The advantages of square wave defibrillator are. obtain a total defibrillation. However cells which are in refractory during the occurrence of first pulse will continue to fibrillate. employed in DC capacitor discharge in the case of DC defibrillators.4 wattsecond as shown in figure above. College 27 . the second pulse operates on latter group of cells.UNIT III ASSIST DEVICES AND BIO . Thus complete EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. In order to.
This method of paddle application offers better control over arrhythmias that occur as a result of atrial activity. The electrodes must be sufficiently well insulated. Anterior-posterior paddles are applied to both the patient's chest wall and back. College 28 . the electrodes must be firmly placed against the patient. The double square pulse with the required pulse-space ratio can be produced with the use of digital circuits similar to those digital pacemaker circuits.TELEMETRY defibrillation can be obtained by means of selecting proper pulse-space ratio. so that the energy is delivered through the heart. These two methods are shown in Figure below. With anterior-anterior paddles. efficient and quick recovery of the heart to beat in the normal manner without any side effect like burning of myocardium or inducement of ventricular or atrial fibrillation. Biphasic DC defibrillator Biphasic DC defibrillator is similar to the double square pulse defibrillator such that it delivers DC pulses alternatively in opposite directions. 6. so that the operator holding the electrodes is safe. The posterior paddle is flat and has a larger disc (with a radial handle) than the anterior paddle (axial handle). Defibrillator Electrodes The two defibrillator electrodes applied to the thoracic walls are called either Anterior-Anterior or Anterior-Posterior paddles. To maintain good contact. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.UNIT III ASSIST DEVICES AND BIO . Using double square pulse defibrillator. both paddles are applied to the chest. This type of waveform is found to be more efficient for defibrillation of the ventricular muscles.
A control switch is located on the handle so that.TELEMETRY (b) (c) (d) (a) Anterior-Anterior Electrode Placement on the Chest (b) Anterior-Posterior Electrode Placement on Chest & Back (c) Paddle-Type External Electrode which is Applied on Chest Wall (d) A Spoon-shaped Internal Electrode which is Applied Directly to the Heart Muscle Two types of electrodes for defibrillation are shown in the above figure. in an insulated housing. approximately 100 mm in diameter. Special pediatric paddles are available with diameters ranging from 2 to 6 cm. College 29 . or it may be applied to the chest of an infant. This electrode consists of a large metal disc. Most defibrillators today have a charging capacity of 400 watts. While being used. the electrodes surface is coated with a conducting gel of the type used with an ECG recording. Figure (d) shows an internal type of electrode which is spoon shaped. once the electrodes are in place. and Figure (c) shows the type of electrode used for external defibrillation.UNIT III (a) ASSIST DEVICES AND BIO . the operator can push the switch to initiate the pulse. The energy of a defibrillator is usually given in terms of watts/sec. referenced across a 50 ohm resistor. In these applications. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. the energy levels required for defibrillation may range from 10 to 50 watts. for applying directly on the myocardium (during open-chest surgery).
where the ventricular rate is too low. College 30 . the use of the pacemaker is temporary .just long enough to start a normal heart rhythm.TELEMETRY Typical defibrillating values used (in watt are as follows: S. By fixing the artificial electronic pacemaker. The output of the pacemaker is applied either externally to the chest or internally to the heart muscle. Most defibrillators include watt meters to indicate the amount of energy stored in the capacitor prior to discharge. the pacemaker is surgically implanted in the body and its electrodes are in direct contact with the heart. the above defects in the heart can be eliminated. But in the case requiring long term pacing.UNIT III ASSIST DEVICES AND BIO . there is usually a 20% loss of energy. In the case of cardiac stand still. it can be increased to normal rate by using pacemaker.No 1 2 3 4 Patient Adult (external) Adult (internal) Pediatric (external) Pediatric (internal) Defibrillating Value 200-400 35-75 100-200 25-50 Due to energy dissipation as heat in components inside the unit and to some extent at the electrode skin interface. In cardiac diseases. PACEMAKER INTRODUCTION: Pacemaker is an electrical pulse generator for starting and/or maintaining the normal heart beat. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.
Ventricular fibrillation is a dangerous condition. For better stimulation and safety purposes. The minimum energy required to excite the heart muscle is about 10 J. Too high a pulse energy may provoke ventricular fibrillation.UNIT III ASSIST DEVICES AND BIO . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The duration of each pulse is between 1 and 2 milli seconds. the heart muscle can be stimulated with an electric shock. During that time.TELEMETRY Energy requirements to excite the heart muscle: Like all muscle tissues. a pulse of 5 V. the stimulus voltage drives energy into the heart muscles. This is caused by a pulse of energy 400 J. a pulse of energy 100 J is applied on the heart muscle. Output pulses from the pacemaker appear at the pair of electrodes used for triggering the heart. 10 mA and 2 milli seconds duration is used.e.. College 31 . The patient loses consciousness in 10-15 seconds and the brain cells die within a few minutes from oxygen deficiency in the brain. The above figure shows the shape of the pacemaker pulses. i. During the pulse duration. The pulse repetition rate is usually 70 pulses/min but many pacemakers are adjustable in the range of 50-150 pulses/min. These pulses should have the pulse to space ratio 1:10000 and that should be negatively going pulses to avoid the ionization of the muscles. The pulse voltage is made variable to allow adjustments in the energy delivered by the pacemaker to the heart during each pulse. the ventricular muscle contracts so rapidly and irregularly that the ventricles fail to fill the blood and circulatory arrest follows.
stainless steel.2. Internal Stimulation: Internal stimulation is employed in cases requiring long term pacing because of permanent damage. Internal Stimulation 1.5 .3. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.3 milliseconds 2.No Parameters 1 Pulse rate 2 Pulse width 3 4 5 6 7 8 9 Pulse amplitude Battery capacity Longevity End-of-life indicator Weight Size Encapsulization Ranges 25 . titanium Methods of Stimulation: There are two types of stimulation 1.80 cm3 Silicon rubber. spoon like electrodes are used. during restarting of the heart after open heart surgery. In some cases. 2.5 .10% dropin pulse rate 33 . S. External Stimulation: External stimulation is employed to restart the normal rhythm of the heart in the case of cardiac stand still.UNIT III ASSIST DEVICES AND BIO .150 mA are employed. The electrodes are in the form of fine wires of teflon coated stainless steel are used. The paddle shaped electrodes are applied on the surface of the chest Currents in the range of 20 .TELEMETRY The typical ranges of parameters of the pacemakers available today are.18 years 2 .10 volts 0.155 pulses per minute 0. Stand still can occur during open heart surgery or whenever there is a sudden physical shock or accident.1 . External Stimulation and 2. College 32 . The currents in the range of 2-15 mA are employed.2 amp-hours 3.98 grams 22 .44 .
Doctor's' help is necessary to rectify the defect in the circuit. College 33 . swelling and During placement swelling and pain 5 pain do not arise due to arise due to foreign body reaction. The electrodes are called The electrodes are called directly to the heart muscle.UNIT III ASSIST DEVICES AND BIO . During placement. External pacemaker and 2. minimum foreign body reaction. External Pacemaker Internal Pacemaker No The pacemaker is placed outside The pacemaker is miniaturized and the body. It may be in the form of is surgically implanted beneath the 1 wrist watch or in the pocket.TELEMETRY Classification of Pacemakers based on placement: Based on the placement of the pacemaker. from skin near the chest or abdomen that one wire will go into the with its output leads are connected heart through the vein. endocardiac electrodes and are applied to the heart by means of an 2 electrode catheter with myocardiac electrodes and are in contact with the outer wall of the myocardium. replaced 4 defect adjustment in the circuit can be easily attended without getting any help from a medical doctor. 6 Here there is no safety for the Here there is a cent percent safety EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Internal (Implanted) pacemaker S. electrode's tip situated in the apex of the right ventricle. These are in contact with the inner surface of the heart chamber. there are two types 1. It does not need the open chest It requires a minor surgery to place 3 surgery The battery and can any be easily or the circuit. The battery can be replaced only by minor surgery. Further any defect or adjustment in the circuit cannot be easily attended.
Mostly 7 these are used for Mostly these are used for temporary heart irregularities permanent heart damages. Atrial synchronous pacemaker 5. Ventricular asynchronous pacemaker (fixed rate pacemaker) This pacemaker is suitable for patients with either a stable. The maximum output voltage is always equal to the modulus of the saturation voltage |Vsat| of the voltage level detector. The period of the square wave generator is given by T = -2RC ln 1−α 1+α Where ‘α’ is the feedback voltage fraction such that α= R2 R1 + R2 The period of the oscillator can be changed by changing ‘α’ or the time constant RC. This produces a stimulus at a fixed rate irrespective of the behaviour of heart rhythm. Ventricular synchronous pacemaker 3.TELEMETRY particularly in the for the circuit from the external the disturbances. a slow atrial rate or atrial arrhythmia. Different modes of Operation: Based on the modes of operation of the pacemakers. total AV block. It is basically a simple astable multivibrator. It consists of a square wave generator (first differential amplifier circuit) and a positive edge triggered monostable multivibrator (second differential amplifier circuit with diodes). of children carrying pacemaker. College 34 . Ventricular inhibited pacemaker (demand pacemaker) 4. Atrial sequential ventricular inhibited pacemaker 1. Ventricular asynchronous pacemaker (fixed rate pacemaker) 2. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 1.UNIT III pacemaker case ASSIST DEVICES AND BIO . they can be divided into five types.
Therefore TD is so chosen such that R R R3 TD = 5Cc 3 4 = -R5 Cm ln R3 + R 4 R3 + R 4 Advantages: 1. Otherwise the trigger would still be present after TD has passed and a second pulse would be wrongly generated. It has the simplest mechanism and the longest battery life. The capacitor Cc is chosen so as to make five time constants equal to the pulse duration TD. It is cheap. 3. College 35 . 2. It is least sensitive to outside interference. A step at the trigger input will pass through the capacitor Cc and the diode will raise the voltage at the lower node (non inverting terminal) of the second differential amplifier. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.UNIT III ASSIST DEVICES AND BIO .TELEMETRY The square wave generator is an astable multivibrator which periodically switches between the output voltages |V sat| and -|Vsat|. The output of the square wave generator is coupled to the positive edge triggered monostable multivibrator circuit.
Possibility for ventricular fibrillation will be more. 3. the heart rate cannot be increased to match greater physical effort. 2. Ventricular Synchronous pacemaker (Standby Pacemaker) Ventricular synchronised pacemaker can be used only for patients with short periods of AV block or bundle block. This varies the stroke volume of the heart causes some loss in the cardiac output. There may be competition between the natural heart beats and pacemaker beats 2. The block diagram of ventricular synch pacemaker is as shown in the figure below. 4. Using the fixed rate pacemaker. College 36 . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. no separate sensing electrode is required.UNIT III ASSIST DEVICES AND BIO . This pacemaker does not compete with the normal heart activity. Stimulation with a fixed impulse frequency results in the ventricles and atria beating at different rates.TELEMETRY Disadvantages: 1. A single transverse electrode placed in the right ventricle senses both R wave as well as delivers the stimulation so.
This ensures that the pacemaker does not interfere with the sinus rhythm. In heart blocks. Therefore the power consumption is reduced 3. If atrial generated ventricular contractions are absent then the pacemaker provides impulses at a basic frequency of 70 impulses/minute. 2. Otherwise the asynchronous pacemaker produces pulses at its preset rate. the asynchronous pacer's timing circuit is reset so that it will time its next pulse to detect heart beat. Advantages: 1. P waves occur at random times with respect to ventricular excitation.TELEMETRY A R wave from an atrial generated ventricular contraction triggers the ventricular synchronised pacemaker which provides an impulse falling in the lower part of the normal QRS complex. this circuit can be used. the fixed rate pacemaker is turned on to pace the heart. The R wave is differentiated by such a filter and its peak to peak amplitude is increased using an input amplifier. If a natural contraction occurs. There is no chance of getting side effects due to competition between natural and artificial pacemaker pulses. The lead used to detect the R wave is now used to stimulate the heart. College 37 . The pacemaker may detect noise and interpret as its ventricular excitation so to eliminate this refractory period circuit or gate circuit is used. To arrest the ventricular fibrillation.UNIT III ASSIST DEVICES AND BIO . the heart rate is detected and is given to the timing circuit in the pacemaker. Working: Using the sensing electrode. A high pass filter with a lower cut off frequency at 20 Hz almost completely eliminates the P wave. If the R-wave occurs with its normal value in amplitude and frequency then it would not work. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. However P and R waves have their principal energy in different frequency bands. Thus it provides impulses only when the atrial generated ventricular contractions are absent. If the detected heart rate is below a certain minimum level.
the asynchronous pacer in the circuit is working up to the returning of the heart into normal one. The sensing electrode picks up R wave. When the R wave is appearing with lesser amplitude. the circuit amplifies it and delivers it in proper form. However if the R wave is missing for a preset period of time. They could not undergo diathermy treatment and could not be exposed to airport security metal detector. stations. When the sensor is slightly stressed or bent by the patient's body activity. microwave ovens. The refractory circuit provides a period of time following an output pulse or a sensed R-wave during which the amplifier in the sensing circuit will not respond to outside signals. College 38 . The sensing circuit detects the R wave and resets the oscillator. If the R wave period is too low or too high. Therefore if the heart rate falls below a predetermined level then pacemaker will turn on and provide the heart a stimulus. But in the newer pacemakers.V. car ignition systems.TELEMETRY 4. pacemaker can automatically increase or decrease its rate. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.UNIT III ASSIST DEVICES AND BIO . Disadvantages: 1. Thus it can match with the greater physical effort. There is also a piezoelectric sensor shielded inside the pacemaker casing. Ventricular Inhibited Pacemaker (Demand Pacemaker) The R wave inhibited pacemaker allows the heart to pace at its normal rhythm when it is able to. 2. For this reason it is called as demand pacemaker. the circuit is more sensitive to external electromagnetic interferences such as electric shavers. and so on. Therefore the patients could not work in radio or T. the pacemaker will supply a stimulus. this is eliminated by connecting a low pass filter in the input circuit of the pacemaker 3. Further they could not ride motor or scooters. air port security metal detectors. In the olden type. Atrial and ventricular contractions are not synchronized.
The output circuit provides a proper pulse to stimulate the heart. Then the output of the pulse width circuit is fed into the rate limiting circuit which limits the pacing rate to a maximum of 120 pulses per minute. rate limiting circuit and output circuit are used to produce the desired pacemaker pulses to pace the heart. In the absence of R wave. The pulse width circuit determines the duration of the pulse delivered to the heart. it allows the oscillator in the timing circuit to deliver pulses at its preset rate. There is a special circuit called voltage monitor which senses the cell depletion and signals the rate slow-down circuit and energy compensation circuit of this event.TELEMETRY The reversion circuit allows the amplifier to detect R wave in low level signal to noise ratio. The timing circuit consists of an RC network. College 39 . pulse width circuit. The output of the timing circuit is fed into pulse width circuit which is also a RC network.UNIT III ASSIST DEVICES AND BIO . a reference voltage source and a comparator which determines the basic pulse rate of the pulse generator. Thus the timing circuit. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.
EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The atrial activity is picked up by a sensing electrode placed in a tissue close to the dorsal wall of the atrium.compensation circuit produces an increase in the pulse duration as the battery voltage decreases to maintain constant stimulation energy to the heart. It can act as a temporary pacemaker for the atrial fibrillation.TELEMETRY The rate slow-down circuit shuts off some of the current to the basic timing network to cause the rate to slow-down 8±3 beats per minute when cell depletion has occurred. College 40 .UNIT III ASSIST DEVICES AND BIO . The detected P wave is amplified and a delay of 0. The block diagram for the atrial synchronous pacemaker is as shown below. 4.12 second is provided by the AV delay circuit. This is necessary corresponding to the actual delay in conducting the P wave to the AV node in the heart. Atrial Synchronous Pacemaker This type of pacing is used for young patients with a mostly stable block. The signal is then used to trigger the resetable multivibrator. The energy .
this pacemaker will stimulate the atrium and then sense the subsequent ventricular beat. If the rate of atrial excitation becomes too fast as in atrial fibrillation or too slow or absent. The stimulus is delivered to the ventricle through the ventricular electrode. Atrial sequential ventricular inhibited pacemaker: It has the capability of stimulating both the atria and ventricles and adopts its method of stimulation to the patients needs. i. This problem has been eliminated by refractory period control circuit. 5.e. Normally pacemaker pulse is so large that it would be detected by the atrial pick up leads and cause the heart to beat.12 second. the pacemaker on sensing this will fire the ventricle at a preset interval of 0.TELEMETRY The output of the multivibrator is given to the amplifier which produces the desired stimulus to be applied to the heart. College 41 . If it is working properly it will discontinue its ventricular stimulating function.UNIT III ASSIST DEVICES AND BIO . However if atrial beat is not conducted to ventricle. a preset fixed rate pacemaker (resetable multivibrator) takes over until the abnormal situation is over.. any signal detected on the atrial lead within 400 milliseconds of a paced heart beat is ignored. If atrial function fails. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.
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