Cardiac Pacemaker Technical Description Paper

Sara Farheen

English/Communication GEND Program, Harrisburg University

ENGL 200: Advanced Composition and Technical Writing

Prof. Doxsee

September 9, 2021

Definition and Statement of Purpose

 Millions of people live with the help of a pacemaker on a day to day basis. As reported

by the American Heart Association, approximately 600,000 pacemakers are implanted each year

and a total of 3 million people worldwide are living with a pacemaker. A pacemaker is not to be

confused with the heart’s natural pacemaker, the sinoatrial node (SA node), which helps the heart

beat in a regular rhythm. The artificial pacemaker, also known as a cardiac pacing device, uses

electrical impulses, delivered by electrodes contracting the heart muscles, to regulate the beat of

the heart. Its primary purpose is to monitor the cardiac patient’s heartbeat and deliver electrical

energy to pace the heart if it’s beating too slow, too fast, or irregularly (Mayo Clinic, para. 1).

Overview

The ability of the four chambered heart to beat 60 to 100 times each minute is made

possible by its muscular structure and mechanism of electrical stimulation. As described by the

Cleveland Clinic resource on pacemakers, electrical impulses generated by the heart’s “natural”

pacemakers, the sinoatrial node (SA node), a bundle of nerve cells embedded in the right atrium,

stimulate the muscles of both the right and left atria (or upper chambers of the heart) to contract,

thereby pushing blood into both the ventricles (or lower chambers of the heart). The wave of

neuronal excitation generated by the SA node passes to the atrioventricular node (AV node),

which is located between the atria and ventricles. Once stimulated, the AV node sends an

electrical impulse which travels through the His-Purkinje network, a pathway of specialized

electricity conducting fibers, and into the muscular walls of the ventricles. The ventricles then

contract and pump blood away from the heart, with blood exiting via either the pulmonary artery,

which runs from the right ventricle to the lungs, or the aorta, which extends from the left

ventricle and connects to arteries leading to the various other parts of the body (para. 3-6).
 Indeed, the coupling of electrical timing with muscular contraction is simultaneously

powerful and intricate. When the electrical impulses that control the heartbeat malfunction,

arrythmias occur, causing the heart to beat too fast, too slow, or irregularly. According to the

Cleveland Clinic resource, pacemakers are used to treat brady-arrythmias, slow heart rhythms

caused by a dysfunction in the heart’s conduction system (such as the SA node, AV node, and

His-Purkinje network). They can also treat various other conditions, some of which include

syncope (unexplained fainting), heart failure, and hypertrophic cardiomyopathy, a condition in

which the heart muscle (myocardium) becomes abnormally thick, making it hard for the heart to

contract and pump blood. (para. 8).

Figure 1

Components of a Cardiac Pacemaker

Figure 1 Note. Adapted from the Cleveland Clinic

 Pacemakers are designed to detect when the heart’s natural rate falls below the rate that

has been programmed into the pacemaker’s circuitry. There are various types of pacemakers

available today, each of which functions differently from the next. Yet, as the Mayo Clinic

resource reports, all pacemakers consist of two main components: a pulse generator with a sealed

lithium battery, and a lead(s) – one or more insulated wires connected to the pulse generator that

terminate in an electrode, through which electrical current enters or leaves the heart. The pulse

generator corrects for a defective SA node or cardiac conduction pathway, by emitting rhythmic

electrical impulses similar to those of the SA node. The pacemaker leads may be placed in the

right atrium, right ventricle, or they may be placed to pace both ventricles, depending on the

condition requiring the pacemaker. (para. 7-9). For instance, atrial fibrillation, a condition

caused by abnormal electrical impulses in the upper chambers of the heart, may be treated with

an atrial permanent pacemaker whose lead is positioned only in the atrium. Also, when the

ventricles are not stimulated normally by the SA node or another natural atrial pacemaker site, a

ventricular pacemaker’s lead is placed in the ventricle. It is also possible to have both atrial and

ventricular arrythmias, and there are pacemakers who have leads positioned in both the atrium

and the ventricle.

Generally, there are three different types of traditional cardiac pacemakers. First, there

are “single-chamber” pacemakers which are positioned either in the right atrium or the right

ventricle. These require only lead. Second, there are “dual-chamber” pacemakers which require

two pacing leads and pace both the right atrium and right ventricle of the heart. Third, there are

“biventricular” pacemakers which require three leads and pace the right atrium as well as both

the right and left ventricles. This treatment is also called cardiac resynchronization therapy

(CRT) (Mayo Clinic, para. 2).

 Traditional pacemakers that control heart rhythm are safe and effective, but when issues

arise, they are mainly related to the leads that connect them to the heart muscle. There is a new

breakthrough in the field of medical science, the leadless pacemakers. Because wireless

pacemakers have no leads and are not implanted under the skin, leadless pacemakers provide the

opportunity of bypassing lead-related complications altogether and are implanted directly into

the heart muscle (Cleveland Clinic, para. 3).

Implanting a traditional cardiac pacemaker does not require an open-heart surgical

procedure. During the surgery, a small incision, approximately 5cm long is made in the upper

chest, just below the collarbone. A thin insulated wire (lead) is then guided through the vein into

the desired position of the patient’s heart. Following this, the surgeon connects the opposite end

of the lead to the pacemaker, which is inserted beneath the skin in the upper chest. As a final

step, the incision is closed (Mayo Clinic, para. 14-15).

Most pacemakers can be checked by the physician remotely, meaning the patient does not

have to visit the physician in-person. The pacemaker is designed to send the patient’s

information: including patient’s heart rate and rhythm, how the pacemaker is functioning, and

how much battery is remaining, directly to the physician. The pacemaker battery lasts

approximately 5 to 15 years. When the battery stops working, surgery is required to replace the

pacemaker with a new battery (Mayo Clinic, para. 23-24).

Final Review

Though there are several different types of pacemakers available in the market, they are

all designed with the same intentions, to treat conditions such as bradycardia, atrial fibrillation,

hypertrophic cardiomyopathy, and various other types of irregular heartbeats by artificially

controlling cardiac rhythm and output with electrical waves that propagate through the heart

muscle (myocardium). Artificial cardiac pacemakers are substantial medical devices that have

prolonged the lives of millions of Americans suffering from cardiac arrythmias and other heart-

related diseases. Through technological advancements in the health sciences and engineering

industries, patients are now able to resume their daily activities without having to worry about

moderate physical exertion.

 References

Mayo Foundation for Medical Education and Research. (2021, September 2). Pacemaker. Mayo

Clinic. Retrieved September 13, 2021, from https://www.mayoclinic.org/tests-

procedures/pacemaker/about/pac-20384689.

Permanent pacemaker: Treatment, prevention, outlook. Cleveland Clinic. (n.d.). Retrieved

September 13, 2021, from https://my.clevelandclinic.org/health/treatments/17360-

permanent-pacemaker