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BIOLOGY
INVESTEGATORY
PROJECT

ARTIFICIAL PACEMAKER

- Harsh Desai
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XII-A

Certificate

This is to certify that Ms./Ma. __ _________

of class 12th_____has successfully completed
this biology project on the topic
_____________suggested by Dr. (Mrs.) Shipra
Chaudhary, during academic session 2020-21
as per the guidelines issued by Central Board
of Secondary Education.

Internal Principal External

Examiner Examiner
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Acknowledgement

I would like to express my special thanks of

gratitude to my teacher “Dr. (Mrs.) Shipra
Chaudhary” as well as our Principal Mam “Mrs.
Nirmal Tondon” who gave me the golden
opportunity to do this wonderful project of
subject Biology on the
topic___________________, which also helped
me in doing a lot of Research and I came to know
about so many new things.
I am really thankful to them. Secondly, I
would also like to thank my parents and friends
who helped me a lot in finalizing this project
within the limited time frame.

Date: Name of student

Class
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INDEX

Sr. No. Topic Pg. No.

1. Introduction 5-6

2. How Pacemaker Works? 7-8

3. History 9

4. Types of Pacemakers 10-12

5. Patients and Family Teaching 13-14

6. Who needs a pacemaker 15-16

7. Risks and Success 17

8. Reference 18
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Introduction

A cardiac pacemaker (or artificial pacemaker, so as not to be

confused with the natural pacemaker of the heart) is a medical device
that generates electrical impulses delivered by electrodes to cause
the heart muscle chambers (the upper, or atria and/or the lower,
or ventricles) to contract and therefore pump blood. By doing so, this
device replaces and/or regulates the function of the electrical
conduction system of the heart.
Pacemakers are the electrode devices that can be used to initiate
the heartbeat when the hearts intrinsic electrical system cannot
effectively generate a rate adequate to support cardiac output.
It is an electronic device used to pace the heart when the normal
conduction pathway is damaged or diseased
COMPONENTS OF PACEMAKER
o Pulse generator - A pulse generator is a small metal case that
contains electronic circuitry with a small computer and a
battery that regulate the impulses sent to the heart
o One or more Leads - The lead (or leads) is an insulated wire
that is connected to the pulse generator on one end, with the
other end placed inside one of the heart’s chambers.
o Pacemaker electrode on each lead – electrode on the end of a
lead touches the heart wall. It also senses the heart’s
electrical activity and relays this information back to pulse
generator via lead.
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HOW PACEMAKER WORKS?

A pacemaker consists of the battery, a computerized generator

and wires with sensors at their tips (called electrodes). Battery
powers the generator and both are surrounded by thin metal box.
The wire connects the generator to the heart.
A pacemaker helps monitor and control the heartbeats. The
electrodes detect heart’s electrical activity and send data through
the wire to the computer in the generator. If heart rhythm is
abnormal, the computer will direct the generator to send electrical
pulse to heart. The pulse travel through the wire to reach the heart.
If the heart rate is lower than programmed limit, an electrical impulse
is sent through lead to the electrode and cause the heart to beat at
faster rate.
When the heart beats are a rate faster than the programmed limit,
the pacemaker generally monitor the heart rate and will not pace.
Modern pacemaker are programmed to work on demand only, so
they do not compete with natural heartbeats. Generally, no
electrical impulses will be sent to the heart unless the heart’s
natural rate falls below the pacemaker’s lower limit.
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HISTORY

In 1889, John Alexander reported of his experiments in which

application of an electrical impulse to the human heart in asystole
caused a ventricular contraction.
In 1926, Mark C Lidwill with Edgar H., devised a portable
apparatus which “plugged into a lighting point” and in which “one
pole was applied to a skin pad soaked in strong salt solution” while
the other pole “consisted of a needle insulated except at its point,
and was plunged into the appropriate cardiac chamber”.
In 1932 Albert Hyman, with his brother, described it as “Artificial
Pacemaker”.
The first clinical implantation into a human of a fully implantable
pacemaker was in 1958 at the Karolinska institute in Solna,
Sweden, using pacemaker designed by inventor Rune Elmqvist
and surgeon Ake Seining (in collaboration with Siemens-Elema
AB), connected to electrodes attached to the myocardium of the
heart beat by thoracotomy. The device failed after 3 hours. A
second device was then implanted which lasted for two days. The
world’s first implantable pacemaker patient, Arne Larsson went on
to receive 26 different pacemakers during his lifetime. He died in
2001, at the age of 86, outliving the inventor as well as the
surgeon.
In 1950, Canadian electrical engineer John Hopps designed and
built the first external pacemaker based upon observations by
cardio-thoracic surgeons Wilfred Gordon Bigelow and John
Callaghan at Toronto General Hospital,[45] although the device was
first tested on a dog at the University of Toronto's Banting Institute.
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TYPES OF PACEMAKERS

PERMANENT PACEMAKER –
 Permanent pacemakers are pacemakers that are intended for
long term use.
 Implanted totally in the body.
 Power source (generator) is implanted subcutaneously usually
over the pectoral muscle on the patient non dominant side.
 They last approx. for 6 to 12 years.
 The permanent generator weighs less than 1 oz and is the size
of a thick credit card.

 Types of permanent pacemaker

1. Single-chamber pacemaker – In this type, only one

pacing lead is placed into a chamber of the heart, either
the atrium or the ventricle, depending on the chamber to
be paced and sensed.

2. Dual-chamber pacemaker –

 Wires are placed in two chambers of the heart.

 One lead pace the atrium and one pace the ventricle.
 Closely resemble the natural pacing of the heart.
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TEMPORARY PACEMAKER –
 Temporary pacemakers are intended for short term use during
hospitalization. Are use to support patients until they improve or
reserve a permanent pacemaker.
 Epicardial wires and the endocardial may be temporary.
 The power source (generator) is located outside the body, and
may be taped to the skin or attach to a belt or to the patient’s
bed.
 Temporary generator size is about the size of a small
paperback book.

 Types of temporary pacemaker --

1. Transvenous invasive pacemaker (endocardial) – It
consists of lead or leads that are threaded tranvenously to
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the right atrium and or right ventricle and attached to

external power source.

2. Transthoracic invasive pacing (epicardial pacing) – It

is achieved by attaching an atrial and ventricle and attached
to epicardium during heart surgery. The leads are passed
through the chest wall and attached to external power
source.

3. Trans cutaneous pacemaker (Non-invasive pacing)

– It is used to provide adequate heart rate and rhythm to the
patients in an emergency situation.
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Patients and Family Teaching

Maintain follow up care with physician to check the pacemaker site

and begin regular pacemaker function checks.
Watch for signs of infection at incision site redness, swelling dressing.
Keep incision dry for 1 week after implantation.
Avoid lifting operative side are above shoulder level until approved by
care provider.
Avoid direct blows to generators or to large magnets such as MRI
scanner. These devices can reprogram a pacemaker.
Microwave oven are safe to use and do not threaten pacemaker
function.
The patient should be taught how to take the pulse.
Carry pacemaker information card at all the times.
COMPLICATIONS
o Hematoma
o Pneumothorax
o Failure to sense or capture
o Perforation of atrial or ventricle septum
o Ventricular atrophy and tachycardia
o Movement or dislocation of lead
o Cardiac perforation
o Infection (endocarditis) – A study done on “Pacemaker
Endocarditis: Clinical features and management of 60
consecutive cases” 89% cases were found to be endocarditis
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related to pacemaker and the causative agent was

staphylococcus.
Prophylactic antibiotics and antibiotics irrigation of the
subcutaneous pocket prior to generator placement has decreased
the rate of infection to less than 2%
If bleeding or hematoma occur, use of cold compresses.
Frequent ECG monitoring to detect cardiac perforation, because
this condition can be recognized by the change in QRS complex
morphology.

Who Needs a Pacemaker?

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Pacemakers are used to treat certain type of arrhythmias, as

well as heart failure, a condition that occur when the heart can
not pump enough blood to the body. Not everyone with an
arrhythmia needs a pacemaker.
Pacemaker for arrhythmias –
 The most common reason people get a pacemaker is
their heartbeats too slowly (brachycardia), or it pauses,
causing fainting spell or other symptoms. In some causes
the pacemaker may also be used to prevent or treat
heartbeat that is too fast (tachycardia) or irregular. These
problems may be caused by:
o Problems with electrical signaling in your heart.
o Beta blockers, which are medicines to lower blood
pressure but also can slow your heartbeat too much.
A pacemaker helps prevent a slow heartbeat when
you need to keep taking this medicine.
o Certain congenital heart defects
o Heart attack
o Heart transplant

Pacemaker for a weak heart

 Pacemaker may also be used to help your heart
chambers beat in sync if your heart is not pumping
enough blood to your body. This can happen because of:
o Certain congenital heart defects
o Enlarge or thick heart muscles that makes it harder
to pump blood out of your ventricle.
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o Heart attack
o Heart failure

Indication of temporary pacing

 Maintenance of adequate heart rate and rhythm during
special circumstances such as surgery and postoperative
recovery, cardiac catheterization or coronary angioplasty.
 Before implantation of a permanent pacemaker.
 As prophylaxis after open heart surgery.
 Acute anterior MI with second degree or third-degree AV
block or bundle branch block.
 Acute inferior MI with symptomatic brachycardia and AV
block.
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RISKS AND SUCCESS

There is about a 1% or less risk of stroke, heart attack, death,

damage to the heart or lungs requiring surgery, including
puncturing the heart but this risk may vary based on the patient's
condition. There is a risk of bleeding and bruising, damage to the
artery, nerves, and veins requiring surgery or transfusions, blood
clots and swelling and infection. There is about a 5% chance of the
lead dislodging requiring reoperation. For about four weeks it is
important to avoid lifting the arm on the side of the pacemaker
above the level of the shoulder to decrease the risk of dislodging
the leads. There is a risk of damage to the lead so repetitive
motion on the side of the pacemaker should be avoided long-term.
Other possible risks of pacemaker insertion include, but are not
limited to, the following:
Bleeding from the incision site
Damage to the vessel at the insertion site
Infection of the incision site
Pneumothorax – air becomes trapped in the pleural space using
the lung to collapse
If patient is pregnant or suspects pregnancy, notify the doctor. If
patients are lactating, or breastfeeding, patients should notify their
doctor.
Patients who are allergic to or sensitive to medications or latex
should notify their doctor.
For some patients, having to lie still on the procedure table for the
length of the procedure may cause some discomfort or pain.
There may be other risks depending upon specific medical
conditions. Be sure to discuss any concerns with the doctor prior to
the procedure.
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REFRENCE

Help from internet, following website links have been used in the
completion of this project file:
 https://stanfordhealthcare.org
 https://www.ncbi.nlm.nih.gov
 https://en.wikipedia.org

Thank You