UNIT III

ASSIST DEVICES AND BIO - TELEMETRY

UNIT III
ASSIST DEVICES AND BIO-TELEMETRY

EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College

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UNIT III

ASSIST DEVICES AND BIO - TELEMETRY

UNIT III

ASSIST DEVICES AND BIO-TELEMETRY

Cardiac pacemakers, DC Defibrillator, Telemetry principles, frequency selection, Bio-telemetry, radio-pill and tele-stimulation.

Biotelemetry:
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

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UNIT III

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

UNIT III

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

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Based on data transmitted a. The waveform is then displayed on an oscilloscope or strip chart recorder as in other patient monitoring systems. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College 5 . Based on transmission distance a. Based on whether user as control over transmission channel or not. The receiver demodulates the frequency modulation signal to recover ECG waveform. 1. The most common use of radio telemetry is to keep track of improving cardiac patients and at the same time keep them ambulatory. Analog b. The receiver station is equipped with a bank of radio receivers tuned to the same frequency as the transmitters.UNIT III 3. ASSIST DEVICES AND BIO . Classification of Telemetry Systems: Telemetry Systems are classified as. 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. Digital 2. 4.TELEMETRY Battery operated amplifiers and transmitters will cause no additional noise as long as no connection with line voltage at patient side. Most transmitters contain an analog ECG section that acquires the signal and uses it to modulate the frequency of the radio transmitters. Short b. These units are sometimes called as post coronary care units (PCCU) or step down CCU. (Electrical Interference of 50Hz). Long 3. Continuous monitoring of the patient can be obtained. Radio Telemetry systems: Many hospitals use radio telemetry systems to monitor certain patients.

The principle of double modulation gives better interference free performance in transmission and enables the reception of low frequency biological signals. Elements of Biotelemetry Systems: The essential blocks of a biotelemetry system are shown in Figure below.TELEMETRY Modulation systems: The modulation system used in wireless telemetry for transmitting biomedical signals makes use of two modulators. The transducer converts the biological variable into an electrical signa1. The transmission line connects the signal input blocks to the read-out device by wire or wireless means. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Where as the final modulator is practically always an FM system. This means that comparatively lower signal frequency carrier is employed in addition to the VHF which finally transmits the signal from the transmitter. The sub-modulator can be a FM system or a PWM system. The signal conditioner amplifies and modifies this signal for effective transmission.UNIT III ASSIST DEVICES AND BIO . College 6 .

The signal is then passed through a stage of conditioning circuit where amplification and processing is done. The receiver detects the radio signals and recovers the signals for further processing. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 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. For a single channel system. 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. FM transmission is often used for telemetry. College 7 . Physiological signals are obtained from the subject by means of appropriate transducers. a miniature battery operated radio transmitter is connected to the electrodes of the patient.UNIT III ASSIST DEVICES AND BIO . Either amplitude modulation or frequency modulation can be used but due to reduced interference. Later the processed signal is transmitted using radio transmitter.

So one additional stage of demodulation is needed to convert the signal from the modulated subcarrier back to its real frequency and amplitude. College 8 . This effect is not distinguishable from the signal at the receiver end. the carrier frequency and amplitude will change. Then the R. the receiver detects the R. At the end. the subcarrier system is needed. The signal is modulated on a subcarrier to convert the signal frequency to the neighbourhood of the subcarrier frequency.F carrier is modulated by this sub carrier carrying the signal.F and recovers the subcarrier carrying the signal. it can be separated by filters. 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. Otherwise the real signal will be distorted by the loading effect. they can be separated by filters.UNIT III ASSIST DEVICES AND BIO .TELEMETRY Radio Telemetry with a subcarrier: When the relative position of transmitter to the body or other conduction object changes. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Since the sub carrier frequency is quite different form all noise interference and loading effect.

At that time. College 9 . multiple channel (multiplex) telemetry system adopted. modulated subcarriers will be separated by the proper band pass filters after the first discrimination (demodulation).UNIT III ASSIST DEVICES AND BIO . carrier. the simultaneous operation of the several single channel units is difficult. it is desirable to have simultaneous recordings of several signals for correlation study. Later the individual signals are recovered from these modulated subcarriers by the second set of discriminators (Demodulators). EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Frequency division multiplexing 2.F. Time division multiplexing Frequency division multiplex System: Each bio-signal is frequency modulated on a subcarrier frequency. At the receiver side.TELEMETRY Multiple Channel telemetry Systems: For most bio-medical experiments. Then these modulated subcarrier frequencies are combined to modulate the main R. There are two types: 1. When the number of channels is more than two or three. Each signal requires a telemetry channel.

EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. time division multiplex system can be used by the time sharing basis. and tn is the sampling time of each channel. The transmission channel is connected to each signal-channel input for a short time to sample and transmit that signal. (i. the process is reversed. At the receiver end.TELEMETRY The frequency of the subcarriers has to be carefully selected to avoid interference.e) fn > 2fsmax 2. the operation is repeated from the first channel. Practically the number of channels allowed is smaller than the calculated value of ‘n' to avoid interference between channels. Time division multiplex System: Most of the biomedical signals have low frequency bandwidth requirements. The sequentially arranged. The scanning frequency fn should be at least greater than twice the maximum signal frequency fs.UNIT III ASSIST DEVICES AND BIO . The low pass filters are used to extract the signals without any noise. When all the channels have been scanned. then the maximum number of channels that can be obtained is n = Tn/tn. the signal in each channel at the receiver side can be recovered without noticeable distortion. signal pulses are distributed to the individual channels by a synchronized switching circuit. so. If the number of scanning cycles per second is large and if the transmitter and the receiver are synchronized. Then the transmitter is switched to the next signal channel in a definite sequence. If Tn = 1/ fn = scanning period. College 10 . Conditions: 1.

2. will travel the GI tract (Gastrointestinal tract) and simultaneously perform multiparameter in physiological analysis.TELEMETRY Radio pill: Radio pill when swallowed. a control chip. After completing its mission it will come out of the human body by normal bowel movement. The outer casing of the pill is made by machining chemically resistant polyetheterketone. The pill comprises an outer biocompatible capsule encasing micro sensors. conductivity and dissolved oxygen in real time. College 11 .UNIT III ASSIST DEVICES AND BIO . sensors. which are joined together by screwing. INSIDE THE CAPSULE: The schematic diagram of the microelectronic pill is as shown in figure below. 1. radio transmitter and two silver-oxide cells. radio transmitter and EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. which is biocompatible.specific integrated circuit (ASIC). application. 3. It is made up of two halves. pH. The pill houses a PCB chip carrier that acts as a common platform for attachment of. The pill is 10mm in diameter and 30mm long weighing around 5gm and records parameters like temperature.

a silicon diode. College 12 . The conductivity sensor is used to monitor the contents of the GI tract by measuring water and salt absorption. inflammatory bowel disease. a pair of direct. It is used to determine the presence of pathological conditions associated with abnormal pH levels. hypertension. ISFET: 1. a 3-electrode electrochemical cell. particularly associated with pancreatic disease. ASSIST DEVICES AND BIO . 2. It is used to measure pH. namely 1. reflux to the oesophagus and the effect of GI-specific drugs on target organs. the activity of fermenting bacteria. the level of acid excretion. Silicon diode: The silicon diode is used to measure the body core temperature and also identify local changes associated with tissue inflammation and ulcers.-contact gold electrodes and 4. 2.UNIT III 4. batteries. 3. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Gold electrodes: A pair of direct contact gold electrode is used to measure conductivity. an ion-selective field effect transistor (ISFET).TELEMETRY Task of the sensors: The device is provided with four micro sensors. bile secretion and the breakdown of organic components into charged colloids.

comprises the silicon diode temperature sensor. The 3mm diameter access channel in the center of each steel clamp exposes the sensing region of the chips to the ambient environment. The integrated radio transmitter sends the signal to a local receiver prior to data acquition on a computer. The sensors are fabricated on two silicon chips located at the front end of the capsule. The transmitter and the ASIC are also integrated on the board. 0. The PCB carrier is made from 1. SENSORS: The schematic diagram of sensor chips is as shown below.The batteries are connected in series and provide an operating time of 40 hours at the rated power consumption of 12. the pH ISFET sensor and the two-electrode 5x 10-4mm2 EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The microelectronic sensors are attached to the PCB chip carrier by a 10 pin. The oxygen sensor measures the oxygen gradient from the proximal to the distal GI tract. thus extending the range of future applications to include (eg.8µm thick sheet of fluoroelastomer seal.1mW. The implementation of a generic oxygen sensor will also enable the development of a first generation enzyme linked amperometric biosensors. The sensor chips are provided at the front end of the pill and are exposed to the ambient environment through access ports. They are scaled by two sets of stainless-steel clamps incorporating an o.) glucose and lactate sensing.5mm pitch polyimide ribbon connector.6mm thick fiberglass board. This enables a variety of syndromes to be investigated including the growth of aerobic bacteria or bacterial infection. The unit is powered by two standard 1.UNIT III ASSIST DEVICES AND BIO . Chip1. College 13 .TELEMETRY 3.55V silver-oxide cells with a capacity of 175mAh.electrode electrochemical cell: The 3-electrode electrochemical cell is used to detect the level of dissolved oxygen in solution.75 x 5mm2. as well as immunosensing protocols. measuring 4.

The microelectrode array has an inter-electrode spacing of 25µm and a combined area of 4. measuring 5 x 5mm2. a microelectrode array of 57x10µm diameter working gold electrodes and an integrated 1. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Chip2. It promotes electrode polarization and reduces response time by enhancing transport to the electrode surface. College 14 .5x 10-3mm2. a 500µm diameter and 10-nL electrolyte chamber and 15x600µm floating gate of the ISFET sensor. comprises the electrochemical oxygen sensor and a NiCr resistance thermometer. The oxygen sensor is embedded in the electrolyte chamber.TELEMETRY conductivity sensor. The 3-electrode electrochemical cell of the oxygen sensor comprises the 1x10-1 mm2 counter electrode made of gold. The 15x600µm floating gate of the ISFET is precovered with a 50nm thick proton-sensitive layer of Si3N4 for pH detection. Predefined n-channels in the p-type bulk silicon form the basis for the diode and the ISFET.UNIT III ASSIST DEVICES AND BIO . The pH sensor consists of the integrated 3x 10-2mm2 Ag/Agcl reference electrode.5x 10-2mm2 Ag/Agcl reference electrode.

The conductivity circuit operates at direct current. An oscillator provides the clock signal. It is then oxidized to Ag/Agcl by chronopotentiometry.TELEMETRY The NiCr resistance thermometer is made from a 100nm thick layer of NiCr and is 5µm wide and 11mm long. College 15 . 10-bit ADC and DAC converters and a digital data processing module. Control chip: The ASIC is the control unit that connects together other components of the microsystem as shown in the figure below. An incorporated potentiostat circuit operates the amperometric EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The 500nm thick layer of thermally evaporated silver is used to fabricate the reference electrode. The temperature circuitry biases the diode at constant current so a change in temperature reflects a corresponding change in diode voltage. It contains an analogue signal conditioning module operating the sensors. 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. measuring the resistance across the electrode pair as an inverse function of solution conductivity.UNIT III ASSIST DEVICES AND BIO .

Conductivity from 0.cm-1( s=siemens). 3. Power consumption: Two SR44 Ag2O batteries are used.8mW at 2. The digital module is clocked at 32KHz and employs a sleep mode to conserve power from the analogue module. 1. 2.8V with the resolution determined by the ADC. Temperature from 0 to 70°C.2msec. pH from 1 to 13. The transmission range is one meter and the modulation scheme frequency shift keying has a data rate of 1 kbps. The bandwidth for each channel is limited by the sampling interval of 0.9mA at 3.2mA of current. College 16 .2mg/litre. which provide an operating time of more than 40 hours of the microsystem. 4. The analogue signals have a full-scale dynamic range of 2. which decides when transmission is required by comparing the most recent sample with the previous sampled data.3mW corresponding to 1.1V supply. Range of measurement: The microsystem can measure. The ASIC and sensor consume 5.01 MHz at 20°C generating a signal of 10KHz bandwidth. Dissolved oxygen up to 8.UNIT III ASSIST DEVICES AND BIO . The digital data processing module processes the digitized signals through the use of a serial bit stream data compression algorithm.TELEMETRY oxygen sensor with a 10-bit DAC controlling the working electrode potential with respect to the reference. These are sequenced through a multiplexer prior of being digitized by the ADC. The transmitter is designed to operate at a transmission frequency of 40. Radio transmitter: The size of the transmitter is 8x5x3mm.7mA of current and the free running radio transmitter consumes 6. The power consumption of the system is around 12.1mW and current consumption is around 3.05 to 10 ms. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.

a) Internal defibrillator (Surgical Type) b) External defibrillator (Therapeutic Type) Internal defibrillator: It is used when chest is opened. The instrument for administering the electric shock is called as defibrillator.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. the contact impedance is about 50 ohms. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.UNIT III ASSIST DEVICES AND BIO . Sometimes electrodes in the form of fine wires of Teflon coated stainless steel are used. College 17 . after that normal heart action may resume. 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. Here large spoon shaped electrodes with insulated handle are used. Since the electrode comes in direct contact with the heart. Ventricular fibrillation is dangerous when compared to arterial fibrillation. Defibrillator types: There are two types of defibrillators based on the electrodes placement. There are AC and DC defibrillator methods but DC defibrillator is used today. 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.

There are AC and DC defibrillator methods but DC defibrillator is used today.5 to 5 milliseconds.TELEMETRY In internal defibrillation. Here paddle shaped electrodes are used. the contact impedance on the chest is about 100 ohms even after applying the gel. The spoon shaped electrode is as shown below. College 18 . the heart requires excitation energy of about 15 to 50 J. the heart requires excitation energy of about 50 to 400 J. The duration of the shock is about 1 to 5 milliseconds. In external defibrillation. Since the electrodes are placed above the chest.UNIT III ASSIST DEVICES AND BIO . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 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. External defibrillator: It is used on the chest. The paddle shaped electrode is as shown below.

DC defibrillator 3. They are. The sensation produced by the fibrillating atria and irregular ventricular action can be quite traumatic for the patient. 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.UNIT III ASSIST DEVICES AND BIO . The atria or the ventricles are unable to respond completely and effectively to each stimulus. 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. AC defibrillator 2. Double square pulse DC defibrillator 6. 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. Under conditions of atrial fibrillation. 1. which applies several cycles of alternating current to the heart from the power line through a step-up transformer. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Synchronized DC defibrillator 4. Hence. AC defibrillator: Although mechanical methods like chest massage for defibrillation have been tried for years.TELEMETRY Mechanism: Fibrillation results from a rapid discharge of impulses from a single or multiple foci in the atria or in the ventricles. Biphasic DC defibrillator 1. Square pulse DC defibrillator 5. College 19 . 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 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.TELEMETRY To achieve defibrillation with internal electrodes placed on the surface of the heart (in open heart surgery). EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. Successive attempts to correct ventricular fibrillation are often required. The transformer must be capable of supplying 4 to 6 amperes current during the stimulus period. 2.UNIT III ASSIST DEVICES AND BIO . Disadvantages: 1. voltages of twice the value are required. The 220V AC main supply is connected to a variable autotransformer in the primary circuit. 2. When external electrodes are used on the chest. College 20 . Capacitive Discharge DC Defibrillators The Capacitive Discharge type DC Defibrillator is as shown in the figure below. There are many disadvantages in using AC defibrillators. voltage ranging from 80 to 300V rms is required. 3. AC defibrillator cannot be successfully used to correct atrial fibrillation.

The energy delivered to the patient is represented by the typical waveform shown in figure above. An AC voltmeter across the primary is calibrated to indicate the energy stored in the capacitor.TELEMETRY A half-wave rectifier rectifies this high AC voltage to obtain DC voltage. College 21 . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 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. which charges the capacitor C. the clinician or technician discharges the capacitor by momentarily changing the switch S from position 1 to position 2. The capacitor is discharged through the electrodes and the patient's torso represented by a resistive load. The area under the curve is proportional to the energy delivered. undesirable current spike that would occur at the beginning of the discharge. limits the charging current to protect the components. Rs.UNIT III ASSIST DEVICES AND BIO . and the inductor L. The inductor is used to shape the wave in order to eliminate a sharp. The wave is monophasic and the peak value of the current is nearly 20 A. A series resistance. With the electrodes firmly placed at appropriate positions on the chest. Five times the RC time constant circuit is required to reach 99% of a full charge-a value it should reach in 10 seconds.

there is a danger of damage to the myocardium and the chest walls. The parallel combination of C1 and C2 stores the same energy as the single capacitor in the above figure. 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. because peak voltages as high as 6000 V may be used. the switch automatically returns to position 1 and the process can be repeated. depending on the size of the capacitor.TELEMETRY Depending on the defibrillator energy setting. Delay-Line Capacitive Discharge DC Defibrillator Even with DC defibrillation. as shown in figure below. The energy stored in the capacitor is given by the equation W= 1 CV2 2 Where. To reduce this risk. Thus. College 22 . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. But its discharge characteristic is more rectangular in shape (1onger duration of approximately 10 m/s) at a much lower voltage. Once the discharge is completed. about 50 to 100 joules only is required for defibrillation. some defibrillators produce dual-peak waveforms of longer duration (approximately 10 m/s) at a much lower voltage. Capacitors used in the defibrillator range from 10 to 50 F. The circuit diagram of such a system is shown in figure below. When the electrodes are applied directly to the heart. if necessary. the voltage for a maximum of 400 J ranges from 2 to 9 KV. C is the capacitance and V is the voltage to which the capacitor is charged.UNIT III ASSIST DEVICES AND BIO .

atrial fibrillation and other arrhythmias it is essential to defibrillator with synchronizer circuit. Simple DC defibrillator can arrest the ventricular fibrillation. If the counter shock falls in the T segment then the ventricular fibrillation is developed.between 50 and 200 watts. The pacemaker is used in the case of emergency as a temporary pacing. College 23 . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. So. Synchronised DC defibrillator: Defibrillation is a risky procedure since if it is applied incorrectly. as to eliminate the ventricular fibrillation or atrial fibrillation without inducing them. DC defibrillator circuit consisting of defibrillator. 3. T wave and U wave segments.TELEMETRY With this type of waveform. There must be proper diagnosis for ventricular fibrillation. effective defibrillation can be achieved in adults with lower levels of delivered energy . If the counter shock falls in the U wave segment then atrial fibrillation is produced. electrocardioscope and pacemaker is as shown in the figure below. 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. it could induce fibrillations in a normal heart. There are two vulnerable zones in a normal cardiac cycle. But for termination of ventricular tachycardia.UNIT III ASSIST DEVICES AND BIO .

2. fibrillation is probable and the fibrillation detector gives an output signal. This is provided by the AND gate 'C'. 3. A defibrillator pulse is delivered only if the fibrillation detector produces an output at the same time that the attendant energizes the switch. 7. then it would not give any output. 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. The AND gate 'B' delivers on signal to the defibrillator only when the ‘R’ wave is absent.UNIT III ASSIST DEVICES AND BIO . By this way the defibrillator is inhibited and would not deliver the defibrillation pulse. College 24 . 4. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 5. The fibrillation detector searches the ECG signal for frequency components above 150 Hz. 6. If they are present. Meanwhile the medical attendant energizes the switch to deliver a defibrillation pulse. connected to the patient who is going to receive defibrillation pulse.TELEMETRY Working: 1. The switch is placed in the defibrillator mode if ventricular fibrillation is suspected. Other it would not give any output if R Wave is present. The electrocardiogram is obtained by means of an ECG unit. At the two inputs of AND gate 'B' if any one of the inputs is missing. provided the signal from the medical attendant is also present at one of the two inputs of that AND gate.

4. Here the defibrillation is obtained at low peak current and so there is no side effect. 9.TELEMETRY Thus when the AND gate B and AND gate C are simultaneously triggering the defibrillator. the defibrillation pulse is delivered.UNIT III 8. Suppose a patient is suffered by atrial fibrillation. ASSIST DEVICES AND BIO . College 25 . This delay of 30 milliseconds after the occurrence of R wave allows the attendant to defibrillate atrium without inducing ventricular fibrillation. At this time. Its output is used to time the delivery of the defibrillation pulse with a delay of 30 milliseconds. The ECG signal in the instrument is given to QRS detector. the defibrillator is synchronised with the ECG unit. Square wave defibrillator: In this defibrillator. capacitor is discharged through the subject by turning on a series silicon controlled rectifier (SCR). the ventricles will be in uniform state of depolarisation and the normal heart beat will not be disturbed. In the synchronization mode. 10. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The output can be controlled by varying the voltage on the capacitor or duration of discharge. When sufficient energy has been delivered to the subject a shunt SCR short circuits the capacitor and terminates the pulse. First the doctor diagnoses it correctly and then the treatment is initiated using this circuit. Digital circuits can also produce a square pulse used for defibrillation.

Energy available from the capacitor.TELEMETRY Analysis In the figure above. Ro is the internal resistance of the defibrillator.skin resistance and RT is the thorax resistance. College 26 . ET is diminised from the available energy due to effects of resistance of defibrillator and electrode-skin resistance. EP = VDIDTD Where. 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. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.EDL .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. The Energy in the pulse is. Total circuit resistance. EC = ID2RTD = ∴ ET = EC . 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. 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 . R = RD + 2RE + RT Further. VD and ID are the instantaneous voltage and current available from the defibrillator pulse respectively and TD is the duration of the pulse.UNIT III ASSIST DEVICES AND BIO .2EEL (Or) ET = EDL + 2EEL + ET RT EC 2 R E + RT + R D Thus the energy delivered to the thorax. EEL = ID2RETD Energy delivered to the thorax. RE is the electrode .

Here 8-60 V double pulse is applied with a mean energy of 2. the second pulse operates on latter group of cells.TELEMETRY Advantages: The advantages of square wave defibrillator are. 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. some of the fibrillating cells will be excitable and will be depolarised. It requires no inductor 3. 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. only lower energy electric shock should be given. Thus complete EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College 27 . 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. It is possible to use physically smaller electrolytic capacitors. Instead of 800 – 1500V. It requires low peak current 2. obtain a total defibrillation.UNIT III ASSIST DEVICES AND BIO . If the chest is opened. 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. In order to.4 wattsecond as shown in figure above. 1. 5. When the first pulse is delivered.

UNIT III ASSIST DEVICES AND BIO . Using double square pulse defibrillator. The electrodes must be sufficiently well insulated. To maintain good contact. Biphasic DC defibrillator Biphasic DC defibrillator is similar to the double square pulse defibrillator such that it delivers DC pulses alternatively in opposite directions. 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. so that the energy is delivered through the heart. With anterior-anterior paddles. the electrodes must be firmly placed against the patient. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 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. Anterior-posterior paddles are applied to both the patient's chest wall and back. These two methods are shown in Figure below. Defibrillator Electrodes The two defibrillator electrodes applied to the thoracic walls are called either Anterior-Anterior or Anterior-Posterior paddles.TELEMETRY defibrillation can be obtained by means of selecting proper pulse-space ratio. College 28 . 6. This type of waveform is found to be more efficient for defibrillation of the ventricular muscles. The posterior paddle is flat and has a larger disc (with a radial handle) than the anterior paddle (axial handle). This method of paddle application offers better control over arrhythmias that occur as a result of atrial activity. both paddles are applied to the chest. so that the operator holding the electrodes is safe.

the electrodes surface is coated with a conducting gel of the type used with an ECG recording. referenced across a 50 ohm resistor.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. the energy levels required for defibrillation may range from 10 to 50 watts. and Figure (c) shows the type of electrode used for external defibrillation. This electrode consists of a large metal disc. once the electrodes are in place. for applying directly on the myocardium (during open-chest surgery). or it may be applied to the chest of an infant. the operator can push the switch to initiate the pulse. The energy of a defibrillator is usually given in terms of watts/sec. Figure (d) shows an internal type of electrode which is spoon shaped. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. approximately 100 mm in diameter. in an insulated housing. In these applications. Special pediatric paddles are available with diameters ranging from 2 to 6 cm. Most defibrillators today have a charging capacity of 400 watts. College 29 . A control switch is located on the handle so that. While being used.UNIT III (a) ASSIST DEVICES AND BIO .

EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. PACEMAKER INTRODUCTION: Pacemaker is an electrical pulse generator for starting and/or maintaining the normal heart beat. Most defibrillators include watt meters to indicate the amount of energy stored in the capacitor prior to discharge. there is usually a 20% loss of energy.TELEMETRY Typical defibrillating values used (in watt are as follows: S. where the ventricular rate is too low. the pacemaker is surgically implanted in the body and its electrodes are in direct contact with the heart. the use of the pacemaker is temporary . In the case of cardiac stand still. the above defects in the heart can be eliminated. College 30 .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.just long enough to start a normal heart rhythm. it can be increased to normal rate by using pacemaker. By fixing the artificial electronic pacemaker. The output of the pacemaker is applied either externally to the chest or internally to the heart muscle.UNIT III ASSIST DEVICES AND BIO . But in the case requiring long term pacing. In cardiac diseases.

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. a pulse of energy 100 J is applied on the heart muscle. During the pulse duration. Output pulses from the pacemaker appear at the pair of electrodes used for triggering the heart. College 31 . The above figure shows the shape of the pacemaker pulses. The pulse repetition rate is usually 70 pulses/min but many pacemakers are adjustable in the range of 50-150 pulses/min.. The patient loses consciousness in 10-15 seconds and the brain cells die within a few minutes from oxygen deficiency in the brain. i. During that time. Too high a pulse energy may provoke ventricular fibrillation.e. the heart muscle can be stimulated with an electric shock. Ventricular fibrillation is a dangerous condition. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. For better stimulation and safety purposes. The duration of each pulse is between 1 and 2 milli seconds. a pulse of 5 V. the stimulus voltage drives energy into the heart muscles.TELEMETRY Energy requirements to excite the heart muscle: Like all muscle tissues. 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. 10 mA and 2 milli seconds duration is used. The minimum energy required to excite the heart muscle is about 10 J.UNIT III ASSIST DEVICES AND BIO . This is caused by a pulse of energy 400 J.

1 .10% dropin pulse rate 33 . Internal Stimulation: Internal stimulation is employed in cases requiring long term pacing because of permanent damage.150 mA are employed.10 volts 0. The paddle shaped electrodes are applied on the surface of the chest Currents in the range of 20 .98 grams 22 .3 milliseconds 2.80 cm3 Silicon rubber. The electrodes are in the form of fine wires of teflon coated stainless steel are used. External Stimulation: External stimulation is employed to restart the normal rhythm of the heart in the case of cardiac stand still. titanium Methods of Stimulation: There are two types of stimulation 1. during restarting of the heart after open heart surgery. The currents in the range of 2-15 mA are employed.2. Stand still can occur during open heart surgery or whenever there is a sudden physical shock or accident.3. S. College 32 .UNIT III ASSIST DEVICES AND BIO .18 years 2 . Internal Stimulation 1. In some cases.44 .2 amp-hours 3.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 . spoon like electrodes are used.155 pulses per minute 0. 2. stainless steel.5 . External Stimulation and 2. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.TELEMETRY The typical ranges of parameters of the pacemakers available today are.5 .

These are in contact with the inner surface of the heart chamber. 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. It may be in the form of is surgically implanted beneath the 1 wrist watch or in the pocket. The battery can be replaced only by minor surgery. replaced 4 defect adjustment in the circuit can be easily attended without getting any help from a medical doctor. External Pacemaker Internal Pacemaker No The pacemaker is placed outside The pacemaker is miniaturized and the body. During placement. electrode's tip situated in the apex of the right ventricle. Doctor's' help is necessary to rectify the defect in the circuit. there are two types 1. Internal (Implanted) pacemaker S. 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. College 33 .TELEMETRY Classification of Pacemakers based on placement: Based on the placement of the pacemaker. minimum foreign body reaction. External pacemaker and 2. from skin near the chest or abdomen that one wire will go into the with its output leads are connected heart through the vein. 6 Here there is no safety for the Here there is a cent percent safety EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.UNIT III ASSIST DEVICES AND BIO . swelling and During placement swelling and pain 5 pain do not arise due to arise due to foreign body reaction. Further any defect or adjustment in the circuit cannot be easily attended. The electrodes are called The electrodes are called directly to the heart muscle.

Ventricular asynchronous pacemaker (fixed rate pacemaker) This pacemaker is suitable for patients with either a stable. a slow atrial rate or atrial arrhythmia. Ventricular synchronous pacemaker 3. Atrial sequential ventricular inhibited pacemaker 1. Different modes of Operation: Based on the modes of operation of the pacemakers. College 34 . Ventricular asynchronous pacemaker (fixed rate pacemaker) 2. 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.UNIT III pacemaker case ASSIST DEVICES AND BIO .TELEMETRY particularly in the for the circuit from the external the disturbances. The maximum output voltage is always equal to the modulus of the saturation voltage |Vsat| of the voltage level detector. of children carrying pacemaker. they can be divided into five types. 1. total AV block. Atrial synchronous pacemaker 5. Ventricular inhibited pacemaker (demand pacemaker) 4. This produces a stimulus at a fixed rate irrespective of the behaviour of heart rhythm. It consists of a square wave generator (first differential amplifier circuit) and a positive edge triggered monostable multivibrator (second differential amplifier circuit with diodes). It is basically a simple astable multivibrator. Mostly 7 these are used for Mostly these are used for temporary heart irregularities permanent heart damages. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.

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. It is least sensitive to outside interference. 2. Otherwise the trigger would still be present after TD has passed and a second pulse would be wrongly generated.TELEMETRY The square wave generator is an astable multivibrator which periodically switches between the output voltages |V sat| and -|Vsat|. College 35 . EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. 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. It has the simplest mechanism and the longest battery life. It is cheap. The output of the square wave generator is coupled to the positive edge triggered monostable multivibrator circuit. 3.UNIT III ASSIST DEVICES AND BIO . The capacitor Cc is chosen so as to make five time constants equal to the pulse duration TD.

The block diagram of ventricular synch pacemaker is as shown in the figure below. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. A single transverse electrode placed in the right ventricle senses both R wave as well as delivers the stimulation so. 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.UNIT III ASSIST DEVICES AND BIO . 4. This pacemaker does not compete with the normal heart activity. Using the fixed rate pacemaker.TELEMETRY Disadvantages: 1. no separate sensing electrode is required. College 36 . 3. Stimulation with a fixed impulse frequency results in the ventricles and atria beating at different rates. 2. There may be competition between the natural heart beats and pacemaker beats 2. Possibility for ventricular fibrillation will be more. the heart rate cannot be increased to match greater physical effort.

The R wave is differentiated by such a filter and its peak to peak amplitude is increased using an input amplifier. In heart blocks. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College 37 . Therefore the power consumption is reduced 3. P waves occur at random times with respect to ventricular excitation. This ensures that the pacemaker does not interfere with the sinus rhythm. the heart rate is detected and is given to the timing circuit in the pacemaker. this circuit can be used.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. the asynchronous pacer's timing circuit is reset so that it will time its next pulse to detect heart beat. If the R-wave occurs with its normal value in amplitude and frequency then it would not work. If atrial generated ventricular contractions are absent then the pacemaker provides impulses at a basic frequency of 70 impulses/minute. Working: Using the sensing electrode. There is no chance of getting side effects due to competition between natural and artificial pacemaker pulses. 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. The lead used to detect the R wave is now used to stimulate the heart.UNIT III ASSIST DEVICES AND BIO . A high pass filter with a lower cut off frequency at 20 Hz almost completely eliminates the P wave. the fixed rate pacemaker is turned on to pace the heart. The pacemaker may detect noise and interpret as its ventricular excitation so to eliminate this refractory period circuit or gate circuit is used. If a natural contraction occurs. Otherwise the asynchronous pacemaker produces pulses at its preset rate. To arrest the ventricular fibrillation. 2. If the detected heart rate is below a certain minimum level. Advantages: 1.

However if the R wave is missing for a preset period of time. Disadvantages: 1. 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. For this reason it is called as demand pacemaker.V. The sensing circuit detects the R wave and resets the oscillator.TELEMETRY 4. stations. the pacemaker will supply a stimulus. Ventricular Inhibited Pacemaker (Demand Pacemaker) The R wave inhibited pacemaker allows the heart to pace at its normal rhythm when it is able to. The sensing electrode picks up R wave. the circuit is more sensitive to external electromagnetic interferences such as electric shavers. the asynchronous pacer in the circuit is working up to the returning of the heart into normal one. 2. When the sensor is slightly stressed or bent by the patient's body activity. College 38 .UNIT III ASSIST DEVICES AND BIO . But in the newer pacemakers. Further they could not ride motor or scooters. Therefore the patients could not work in radio or T. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. this is eliminated by connecting a low pass filter in the input circuit of the pacemaker 3. Therefore if the heart rate falls below a predetermined level then pacemaker will turn on and provide the heart a stimulus. the circuit amplifies it and delivers it in proper form. air port security metal detectors. There is also a piezoelectric sensor shielded inside the pacemaker casing. pacemaker can automatically increase or decrease its rate. When the R wave is appearing with lesser amplitude. microwave ovens. car ignition systems. Thus it can match with the greater physical effort. In the olden type. They could not undergo diathermy treatment and could not be exposed to airport security metal detector. Atrial and ventricular contractions are not synchronized. and so on. If the R wave period is too low or too high.

it allows the oscillator in the timing circuit to deliver pulses at its preset rate. The timing circuit consists of an RC network. The pulse width circuit determines the duration of the pulse delivered to the heart. pulse width circuit. The output of the timing circuit is fed into pulse width circuit which is also a RC network. College 39 . The output circuit provides a proper pulse to stimulate the heart. In the absence of R wave. Thus the timing circuit.UNIT III ASSIST DEVICES AND BIO . rate limiting circuit and output circuit are used to produce the desired pacemaker pulses to pace the heart. a reference voltage source and a comparator which determines the basic pulse rate of the pulse generator. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg.TELEMETRY The reversion circuit allows the amplifier to detect R wave in low level signal to noise ratio. 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. 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.

College 40 . It can act as a temporary pacemaker for the atrial fibrillation. 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.UNIT III ASSIST DEVICES AND BIO .12 second is provided by the AV delay circuit.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. The atrial activity is picked up by a sensing electrode placed in a tissue close to the dorsal wall of the atrium. 4. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. The signal is then used to trigger the resetable multivibrator.compensation circuit produces an increase in the pulse duration as the battery voltage decreases to maintain constant stimulation energy to the heart. The detected P wave is amplified and a delay of 0. The block diagram for the atrial synchronous pacemaker is as shown below. The energy .

e.UNIT III ASSIST DEVICES AND BIO . If it is working properly it will discontinue its ventricular stimulating function. This problem has been eliminated by refractory period control circuit. The stimulus is delivered to the ventricle through the ventricular electrode. 5. 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. the pacemaker on sensing this will fire the ventricle at a preset interval of 0. EC1006 – MEDICAL ELECTRONICS / Panimalar Engg. College 41 . Normally pacemaker pulse is so large that it would be detected by the atrial pick up leads and cause the heart to beat. this pacemaker will stimulate the atrium and then sense the subsequent ventricular beat. any signal detected on the atrial lead within 400 milliseconds of a paced heart beat is ignored.TELEMETRY The output of the multivibrator is given to the amplifier which produces the desired stimulus to be applied to the heart.. i. If atrial function fails. a preset fixed rate pacemaker (resetable multivibrator) takes over until the abnormal situation is over. However if atrial beat is not conducted to ventricle. If the rate of atrial excitation becomes too fast as in atrial fibrillation or too slow or absent.12 second.

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