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MarkW.Sweesy,FHRS,CCDS,CEPS y, , , ArrhythmiaTechnologiesInstitute
Outline O tline
OhmsLaw Ohm sLaw
Voltage,currentandresistance(impedance) E Energyandpower d Clinicalrelevance
Strengthdurationcurve
Rheobase Chronaxie Clinicalrelevance Cli i l l
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OhmsLa OhmsLaw
V IxR
TheequationusescurrentintheformofAmps InpacingcurrentisexpressedinmA
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F ndamentalsofElectronics FundamentalsofElectronics
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FundamentalsofElectronics
g HighResistance=lowcurrentflow
LowResistance=highcurrentflow
PPP{
V V
PW
PW
R I I
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OhmsLa OhmsLaw
Whatisthecurrentina2.5voltsystemwitha 500 resistance?
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OhmsLa OhmsLaw
I=V R = 2.5V 500 = .005A .005Ax1000mA 1A
Whatisthecurrentina2.5voltsystemwitha500 resistance?
=5mA 5
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15.Apatientsstimulationthresholdwas1.0Volt&0.2 msecpulseduration.Thepacemakerisprogrammed p p p g to2.0Volt&0.4msecduration.Leadimpedance measures1000Ohms.Theoutputenergyforthis measures1000Ohms Theoutputenergyforthis patientwouldbe: a. a 2Xthreshold b. 4Xthreshold c. 6Xthreshold h h ld d. 8Xthreshold
E=
12 x .2 = .2
2 V
xt R
22 x .4 = 1.6 1000
1000
Doubling the voltage is 4 times the energy and doubling th PW i 2 ti d bli the is times th energy the
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LeadImpedanceandEnergy LeadImpedanceandEnerg
Energ V I T Energy=VxIxT
PacemakerPulse Widths=.11.5ms 4.0Vx 8.0mAx 5ms=20uJ 4 0Vx 8 0mAx .5ms 20uJ ICDPulseWidths=315msrange1 75 750Vx 14,000mAx 3ms=31.5J 4, 3 3 5 or31,500,000uJ
1. Thammanomai A, et al. Heart Rhythm 2006; 3:1053-1059
Charge
Inpacing,chargedescribestheamountofelectricity Inpacing chargedescribestheamountofelectricity Inpacing,chargedescribestheamountofelectricity pacing deliveredtothemyocardiumduringanatrialor deliveredtothemyocardiumduringanatrialor ventricularoutput. ti l t t Charge(Q)istheproductofpulseduration(t)in Charge(Q)istheproductofpulseduration(t)in milliseconds&outputcurrent(I)inmilliamperes.In milliseconds&outputcurrent(I)inmilliamperes.In pacingitisusuallyexpressedinmicrocoulombs. pacingitisusuallyexpressedinmicrocoulombs. i iti ll di i l b Q=IxT
Power Po er
Poweristherateofdoingworkortransmitting energy. PowerP=Ix PowerP=Ix V:wherePisinwatts,Iisinamperes andVisinvolts. andVisinvolts
QuiescentCurrent
Housekeeping currentutilizedwhennotpacing;i.e., H Housekeeping k i t tili d h t i i currentusedforongoingtaskslikemonitoringtheintrinsic rhythm&loggingdata.Typicallyinthe8 A rhythm&loggingdata.Typicallyinthe812uArangefor h th &l i d t T i ll i th 8 f pacemakers Reducingtheoutputfrom4.0to2.0Vmayincreasethe batterylongevityfrom4to6yrs,stillhavehousekeeping y g y 4 y , p g needs
BipolarUnipolar
LowImpedance
Insulationdegradation,Yadaptororparallelpathways, looseconnectionmaintainingcontactwithbodyfluids1
1. In Ellenbogen K, et al. Clinical Cardiac Pacing, Defibrillation & CRT. 2007; pp 834
MeasuredData
Ifyoucouldonlypick3valuesonwhichtobaseyourdevice If ld l i k l hi h b d i evaluation;which3wouldyoupick?
MeasuredData
Ifyoucouldonlypick3valuesonwhichtobaseyourdevice If ld l i k l hi h b d i evaluation;which3wouldyoupick?
StrengthDurationCurve
Agraphicrepresentationofthepulseamplitude, involtageorcurrent,requiredtoproducean i lt t i dt d actionpotentialinthecells.Thecurveisplotted asafunctionofpulsedurationandcanbedefined f ti f l d ti d b d fi d by2points;theRheobase andtheChronaxie.As by2points;theRheobase andtheChronaxie.As thepulsedurationincreasesthevoltage th l d ti i th lt requirementsdecline(toapoint).
capture
Rheobase
Thevaluederivedfromastrength Thevaluederivedfromastrengthdurationcurvethat indicatestheminimumoutputthatwillstimulatethe myocardiumirrespectiveofthepulseduration.Thecurve myocardiumirrespectiveofthepulseduration Thecurve typicallylevelsoutaroundapulsedurationof1msec typicallylevelsoutaroundapulsedurationof1msec
Chronaxie
Thepulsedurationvaluethatistwicetherheobase. Thepulsedurationvaluethatistwicetherheobase
26.Theterm 6 Th orfibrous fib capsulesurroundingtheelectrode: a. isanormalforeignbodyreaction p b. isan unexcitablecapsuleoftissue c. decreasesthecurrentdensityatthelead tissueinterface d. alloftheabove
^AfA
^AfA
^AfA
VirtualElectrode
isanormalforeignbodyreactionwhichresultsfromacute injurytothecellmembrane collagenisformedresultinginanunexcitablecapsuleof collagenisformedresultinginanunexcitablecapsuleof g g p tissuewhichdecreasesthecurrentdensityattheleadtissue interface
^AfA
^AfA
^AfA
^AfA ^f
ElectrodeThreshold Characteristics
1.2 12
A B C D
Implanttime(weeks) I l tti ( k )
Ellenbogen&Woods.CardiacPacing&ICDs,p 53
OutputProgramming
Ruleofthumb R l f h b DoubleVoltage DoubleVoltage TriplePW p
DoublingVoltage
Chronicthreshold Chronicthreshold .5ms&2.5Vsovoltage 5ms&2 5Vsovoltage wasdoubled TriplingPWwould giveaninadequate g q safetymargin
VoltageStrengthDurationCurve g g
bestprogramming
OutputSettings&Longevity O tp tSettings&Longe it
AntiarrhythmicsThatIncrease y PacingThresholds
ClassIA
Quinidine Disopyramide Procainamide
ClassIC
Flecainide Flecainide notorious Propafenone p
ClassIII
Amiodorone *Sotalol *Sotalol decreasesICDthresholds Prapafenone
ElectrolyteAbnormalitiesThat y IncreasePacingThresholds
Acidosis Alkalosis Hyperkalemia Hypocalcemia Hyperglycemia Hypercarbia yp Hypoxemia
TemporalConditionsThat p IncreasePacingThresholds
Sleeping Acuteviralillness Eating Leadmaturation Excessivealcohol increasesdefibrillationthresholds1 Excessivealcohol increasesdefibrillationthresholds
Papaioannou GI,etal.PACE2002;25:1144
FactorsThatDecreasePacing g Thresholds
Corticosteroids Corticosteroids dexamethasone Exercise Catecholamines Hypocapnia Sympathomimeticagents Isuprel,epinephrine,ephedrine, Sympathomimeticagents Isuprel,epinephrine,ephedrine, atropine Hyperoxia
Whatsthepoint?
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OhmsLa OhmsLaw
Whatwouldbethecalculatedvoltagein a10mA systemwith500 ofimpedance?
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OhmsLa OhmsLaw
Whatwouldbethecalculatedvoltageina10mA systemwith 500 ofimpedance?
V=IxR
TriplingPulseWidth
Chronicthreshold 2.5V&.2msPW, PWprogrammed d to.6msproviding a2.1xsafety margin.
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ClClCl- Cl Cl-
e- e
Electrode-Tissue Interface
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GardenHoseAnalogy GardenHoseAnalog
NormalResistance=normalcurrentflow
LowResistance=highcurrentflow
HighResistance=lowcurrentflow
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FundamentalsofElectronics
Terminology T i l
Current:flowofelectronsthroughacircuitmA Current:flowofelectronsthroughacircuitmA
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CurrentFlow
Pacemaker P k
Conductor Wire Wi
Heart e-
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Voltage:Electromotivepush
e
Pacemaker
Providedby y Thebattery
Conductor Wire
Heart
V = IR
Oh L Ohms Law
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OhmsLa OhmsLaw
Whatwouldbetheimpedanceofa2.5voltsystemwitha10mA currentdrain?
R=V = I
2.5V 10mA
= 2.5V .01A
250
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F ndamentalsofElectronics FundamentalsofElectronics
Energy:Voltagex Currentx Time Energy:Voltagex Currentx
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FundamentalsofElectronics
LowResistance=highcurrentflow
PW
HighResistance=lowcurrentflow
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F ndamentalsofElectronics FundamentalsofElectronics
SystemImpedance
CathodeElectrodeImpedance AnodeElectrodeImpedance PolarizationImpedance PolarizationImpedance TissueImpedance
Energy,Power,Watts&CurrentDrain gy, ,
Energy:theabilitytodowork;forbatteriesusuallyexpressedin watt watthours1 Energydensity:theenergycontentofabatteryorcapacitorbased onvolumeormass.Forabatteryisexpressedinunitsofwatt onvolumeormass.Forabatteryisexpressedinunitsofwatthrs percubiccentimeterorwatt percubiccentimeterorwatthrspergram1 Power:therateofdoingworkortransmittingenergy,aproductof voltage¤tusuallyexpressedinwatts2 Watt:internationalunitofelectricalpower,wattsareequivalentto joulespersecond2 Watthour:theamountofenergyatarateof1wattperhour,1 Watthour theamountofenergyatarateof1wattperhour 1 joule=1wattdeliveredfor1second,1watthour=3,600joules2 joule=1wattdeliveredfor1second,1watt Currentdrain:theaverageamountofcurrentdrawnfromabattery bytheexternalload;typicallypacemakersdrawfrom10 bytheexternalload;typicallypacemakersdrawfrom10 30 microamperes2
1. In Ellenbogen K, et al. Clinical Cardiac Pacing, Defibrillation & CRT. 2007; pp 236
2. In Hayes &Asirvatham. Dictionary of Cardiac Pacing, Resynchronization, & Arrhythmias. 2007
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