Lec3 2019

electrode
Performance:
1- Unipolar
o A single electrode is in contact with the heart, and negative-going pulses
are connected to it from the generator.
o A large indifferent electrode is in contact located somewhere else in the
body, usually mounted on the generator, to complete the circuits.
2- Bipolar
o In the bipolar system, two electrodes are placed within or on the heart, and
the stimulus is applied across these electrodes.
36 Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
Electrodes
Figure 13.2 Unipolar and bipolar implementations of both J-shaped and nonpreshaped leads. All models have distal
cathode. Bipolar designs typically have a ring anode proximal 10–15 mm on the lead. From J. G. Webster, Ed., Design of
cardiac pacemakers, New York, IEEE Press, 1995.
Electrodes
To place a pacemaker, a lead wire is inserted into the cephalic vein of the shoulder and fed into the heart
chambers (B). An electrode is implanted in the heart muscle of the lower chamber, and the device is
attached (C).
Electrodes Passive Fixation
• The tines become lodged in the trabeculae (fibrous meshwork) of the heart
Electrodes Active Fixation
• The helix (or screw) extends into the endocardial tissue
• Allows for lead positioning anywhere in the heart’s chamber
Unipolar Pacing System
• Contains a Lead with Only One Electrode Within the Heart
• The pulse:
– Flows through the tip
electrode (cathode)
– Stimulates the heart
– Returns through body fluid
and tissue to anode
- Unipolar leads may have a smaller
diameter lead body than bipolar leads
- Unipolar leads usually exhibit larger
pacing artifacts on the surface ECG
Bipolar Pacing System
• Contains a Lead with Two Electrodes Within the Heart
• The pulse:
– Flows through the tip electrode located at
the end of the lead wire
– Stimulates the heart
– Returns to the ring electrode above the lead tip
- Bipolar leads are less susceptible to over
sensing non-cardiac signals (myopotentials
and EMI)
• Diameter 4-5 F
(1French = 0,33mm)
Bipolar intraluminal & Intramyocardial electrodes
Cardiac Pacemakers-Design Requirements
Illustration of implanted cardiac pacemaker showing

locations of cardiac pacemaker leads
Cardiac Pacemakers-Design Requirements
Fluoroscopy_pacemaker_leads_right_atrium_ventricle Cardiac_resynchronisation_therapy
Medical Therapeutic and Support
Systems
EQUP5335
LECTURE 3
46
Medical Therapeutic and Support Systems - EQUP 5335 Lecturer : Eng. Abdulhamid Seyam
video
Periodic pacemaker checkups
 it is periodically checked to ensure the device is operational and
performing appropriately.
 Routine pacemaker checks are typically done in-office every six (6)
months, though will vary depending upon patient/device status and
remote monitoring availability
 At the time of in-office follow-up, the device will be interrogated to

perform diagnostic testing.
Periodic pacemaker checkups
 perform diagnostic testing. These tests include:
• Sensing: the ability of the device to "see" intrinsic cardiac activity (Atrial
and ventricular depolarization).
• integrity. Large and/or sudden increases in impedance can be indicative of a

lead fracture while large and/or sudden decreases in impedance can signify
a breach in lead insulation.
• Threshold Amplitude: The minimum amount of energy (generally in
hundredths of volts) required in order to pace the atrium or ventricle
connected to the lead.
• Threshold Duration: The amount of time that the device requires at the
preset amplitude to reliably pace the atrium or ventricle connected to the
lead.
Two types of remote monitoring
devices used by pacemaker patients
 Cont….
• Percentage of Pacing: Defines how dependent the patient is on the device,
the percentage of time that the pacemaker has been actively pacing since
the previous device interrogation.
• Estimated battery life at current rate: As modern pacemakers are "on-

demand", meaning that they only pace when necessary, device longevity is
affected by how much it is utilized.
• Other factors affecting device longevity include programmed output and

algorithms (features) causing a higher level of current drain from the
battery.
• An additional aspect of the in-office check is to examine any events that
were stored since the last follow-up.
ElectricalStimulation
◦muscle stimulator
◦cochlear prosthesis
◦ bladder stimulator
◦suppression of pain
Electrical Stimulation
 In physical therapy to determine the contractibility of a muscle
 Exercise of the temporary paralyzed muscle from muscle atrophy due to disuse:
prevent the reduction of the muscle mass
 Functional electric stimulation (FES)
 Muscle paralysis due to neurologic injuries

 Many electrodes with different stimulation sequence from a controller
produce movement
 Patient controls the stimulators using normal muscle contractions (ex,
contralateral shoulder)
 Functional electric stimulation (FES)
_ Used for regain function of paralyzed muscles
_STIMULATION OF UPER EXTEREMITIES( controlling a hand )

_STIMULATION OF LOWER EXTERMETIES(Enable, Paraplegic patients to
stand ,…, - Drop foot Prosthesis )
Dropfoot prothesis (Fig. )
- Patients with strokes
- Gait problem known as drop foot (unable to lift the ball of the foot
susceptible to tripping)
- Mostly constant-current types charge transfer per pulse is constant

for varying load impedance
- Pulse current of 2 ~ 20 mA with pulse duration of 1 ms
- Peak voltage of 3 ~ 30 V at the electrodes depending on the load
FES(FunctionalElectricalStimulation)
Drop foot Prosthesis
A stimulator system for use on stroke patients

suffering from gait problems associated with drop
foot.
FES(FunctionalElectricalStimulation)
Drop foot Prosthesis
Schematic diagram of three-channel implanted stimulator; stimuli on the electrodes with different time delays for the
synchronization of muscles to achieve motion
Pain Suppression and Transcutaneous Nerve Stimulation
 Postoperative pain or pains related with terminal cancer
Battery-powered or transcutaneous RF-powered stimulators
 Gate-control theory of pain: stimulation of certain neurons can have a inhibitory

effect on the transmission of pain information through peripheral nerves to the
spinal cord
Pain Suppression and Transcutaneous Nerve Stimulation
TENS
 From monopolar rectangular to biphasic spike pulses
 Modulations: amplitude, width, rate, or burst
 Up to 60 V and 50 mA, 2 ~ 200 pulses/s, 20 ~ 400 ms pulse width, 2 per second burst
rate
 Wide variety of skin surface electrodes (ex, strips of silicone elastomer made
conductive by loading with carbon particles)
 Pain suppression effect is not well understood, Placebo effect (?)

Cochlear Prosthesis
Cochlear Prosthesis
Restoration of lost hearing.
• People with extreme hearing loss that originates in the inner ear may
benefit from a cochlear implant.
• This prosthesis stimulates the cochlear nerve directly, bypassing the
receptor cells of the inner ear(bypassing nonfunctional hair cells ), and
may allow the recipient to hear medium to loud sounds.
• The cochlear implant system really consists of an implanted stimulator
connected to an electrode array inserted in the cochlea and an external
speech processor that codes the speech into stimulation patterns that
can be translated back into sounds by the brain.
Cochlear Prosthesis
Block diagram of a cochlear prosthesis
Cochlear Prosthesis
• The external speech processor also powers the implant via an inductive
energy transfer link.
• Encoding of speech into stimulus patterns - limited recognition of
words
• Cochlear implants are now common and provide substantial benefits to
many profoundly deafened children and adults.
• Benefits vary by person and range from increased perception of
environmental sounds to the ability to use a telephone
Visual Prosthesis
 Electrical stimulation of the occipital cortex and the
optic nerve - sensation of light
for a certain types of blindness
 Miniature array of stimulating electrodes
 Research area
Bladder stimulator
Bladder stimulator
• Bladder Stimulators used for
Urinary incontinence and other neurological bladder dysfunction
Urinary incontinence
• Week sphincter muscle surrounding the urethra
• Increased pressure within the bladder due to coughing or laughing
• Neurologically excited excessive contraction of the detrusor muscle of the
• bladder

Electrical stimulator for urinary incontinence
• Electrodes in or near the muscles or nerves involved in sphincteric control
of the urethra (implantation, vaginal or anal insertion)
• Pulse duration of 0.5 ~ 5 ms for muscle electrodes or 100 ~ 400 ms for
neural electrodes
• Pulse repetition rate of 20 ~ 100 pulses/s
• Average stimulating current of about 1 mA
Bladder Neurostimulator
• This enables the person to perceive the sensation of bladder fullness and
the desire to empty the bladder, spontaneously and completely.
• The intensity and frequency of the impulses generated by the neuro
stimulator can be modified by both the physician and the patient through
an external programmer
Electrical stimulator to help patients void
• Externally controlled stimulator causes the detrusor muscle to contract
• Multiple electrodes on or within the bladder wall or on the spinal nerves
that innervate the bladder
• Receives power from external device by transcutaneous RF transmission
• Multiple implanted stimulators can communicate with an external
controller
• Transcutaneous RF powered electric stimulator (next Fig.): for
continuous stimulation
Electrical stimulator for urinary incontinence
• Transcutaneous RF powered
electric stimulator (): for
continuous stimulation
Figure 13.7 A transcutaneous RF-powered electric stimulator Note that the

implanted circuit of this stimulator is entirely passive and that the amplitude of
the pulse supplied to the electrodes is dependent on the coupling coefficient
between the internal and external coils.
Thank You
Any question ?!
Thank You
Any question ?!
Any question ?!

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electrode

Illustration of implanted cardiac pacemaker showing

 At the time of in-office follow-up, the device will be interrogated to

• integrity. Large and/or sudden increases in impedance can be indicative of a

• Estimated battery life at current rate: As modern pacemakers are "on-

• Other factors affecting device longevity include programmed output and

 Functional electric stimulation (FES)

 Muscle paralysis due to neurologic injuries

_ Used for regain function of paralyzed muscles

_STIMULATION OF UPER EXTEREMITIES( controlling a hand )

- Mostly constant-current types charge transfer per pulse is constant

- Pulse current of 2 ~ 20 mA with pulse duration of 1 ms

- Peak voltage of 3 ~ 30 V at the electrodes depending on the load

A stimulator system for use on stroke patients

Battery-powered or transcutaneous RF-powered stimulators

 Gate-control theory of pain: stimulation of certain neurons can have a inhibitory

 Modulations: amplitude, width, rate, or burst

 Pain suppression effect is not well understood, Placebo effect (?)

Block diagram of a cochlear prosthesis

Figure 13.7 A transcutaneous RF-powered electric stimulator Note that the

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