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FundamentalElectricalRelationships: FundamentalElectricalRelationships OhmsLaw,StrengthDurationCurve& FactorsAffectingThresholds

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

V=IxR I=V/R R=V/I

TheequationusescurrentintheformofAmps InpacingcurrentisexpressedinmA

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F ndamentalsofElectronics FundamentalsofElectronics

Voltage(V):forcemovingthecurrent:electromotive push Current(I):flowofelectronsthroughacircuitmA Current(I):flowofelectronsthroughacircuitmA Resistance(R)/Impedance:oppositiontocurrent flow:unitofmeasure:Ohm() nitofmeasure:Ohm(

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FundamentalsofElectronics
g HighResistance=lowcurrentflow

LowResistance=highcurrentflow

PPP{
V V

PW

PW

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OhmsLaw:Pacers sICDs OhmsLa PacersvsICDs OhmsLaw:PacersvsICDs


Typicalrangeforpacemakervoltage1.05.0V yp g p g TypicalrangeforICDvoltage50800V Typicalrangeforpacemakercurrent216mA TypicalrangeforICDcurrent1,00075,000mA TypicalrangeforICDcurrent1 000 75 000mA Typicalrangeforpacingleadimpedance:3001200Ohms T i l f i l di d Oh Typicalimpedancerangeforahighvoltagelead1060Ohms

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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

Whentheimpedanceis500ohmstheabsolutevalueofthecurrentis2x sthevoltage Whentheimpedanceis500ohmstheabsolutevalueofthecurrentis2xsthevoltage

18.Aleadfracturewouldresultinwhichofthefollowing? 18 Aleadfracturewouldresultinwhichofthefollowing? a. decreasedbatterylongevity b. b decreasedconductorimpedancevalues c. decreasedelectrodeimpedancevalues d. decreasedcurrentdrain d d d d

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Energ Form la EnergyFormula


E=Vx IxPW E=V E Vx Ix Vx E=V2x PW E=V R E=I Rx E=I2x Rx PW

IfyouleavecurrentinmA andtimein y Msec youranswerwillbeinuJ

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

22.Whatistheestimatedbatteryservicelifeofa pacemakerwitha1.0Amphourbatteryanda20 k ith A h b tt d microampcurrentdrain? a. 4.0years 5 y b. 5.0years c. 5.7years d. 10.0years d 10 0years

1.0 Amp hour 1 0 Amp-hour battery and a 20 microamp current drain

Time = Q battery capacity in Ah y p y I current drain in amperes


Time = 1 000 000 uA/hr = 50 000 hr = 5.7 yrs 1,000,000 50,000 57 20 uA 8,760 hr/yr , y

FactorsAffectingCurrentDrain acto s ect g Cu e t a


Lead/tissueinterface Stimulationthreshold&safetymarginsdesired Quiescentcurrent Impedance Electrodedesign&materials Pacemakersprogrammedsettings %pacing

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

Fracture/Connector/U i L d Fracture/C F t /Connector/Uni Leads /C t /Uni /U

Causes o g & o CausesofHigh&LowImpedance peda ce


HighImpedance
ConductorFracture,LooseConnectororUnipolarleads programmedtoBipolar

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?

StimulationThreshold Stim lationThreshold


Theminimalamountofelectricalstimulation thatconsistentlyproducesacardiac depolarization.Thethresholdcanbe depolarization Thethresholdcanbe expressedintermsofamplitude (milliamperes orvolts),pulseduration(msec), orvolts),pulseduration(msec), charge(microcoulombs),orenergy charge(microcoulombs),orenergy (microjoules). microjoules).

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

17.Whichoftheabove3monthstimulation thresholdgraphswouldbemostcharacteristic ofsteroidelutingtinedatriallead? a. a A b. B c. C d. D

^AfA ^f

ElectrodeThreshold Characteristics
1.2 12

Puls sewidth h(ms)

1.0 0.8 0.6 0.4 0.2 02 0.0 1 10 11 13 2 7 8 ^f ^AfA 14 3 4 6 5 9 12

Polishedplatinum Porousplatinum Activatedcarbon Steroidelutingtinedlead

A B C D

Implanttime(weeks) I l tti ( k )

Thedifferencenotedinthresholdswhendecrementing untillossofcaptureversusgoingfromsubthresholdto untillossofcaptureversusgoingfromsub thresholdto captureisknownas? a. l t latency b. Wedenskyeffect c. intermittentthreshold p d. polarization

Wedensk Effect WedenskyEffect


Alsocalledcapturehysteresis Thedifferencenotedinthresholdswhendecrementing g untillossofcaptureversusgoingfromsub untillossofcaptureversusgoingfromsubthresholdto capture p Ellenbogensuggeststhephenomenaisprobably explainedbyvaryingratesduringgainorlossofcapture l i db i t d i i l f t andthateffectsmaybegreatestatnarrowpulsedurations

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

63.IfthethresholdwasdeterminedtobeatpointCintheabove 3 p figure;whichofthefollowingwouldresultinanefficientand appropriatesafetymargin? pp p y g a. Doublevoltage b. Triplethepulsewidth c. Triplethevoltage d. Doublethepulsewidth

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

10mAx500 =5000 5000mVx1V 1000mV 5V

TriplingPulseWidth
Chronicthreshold 2.5V&.2msPW, PWprogrammed d to.6msproviding a2.1xsafety margin.

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OhmsLawtattoo OhmsLa tattoo

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Polarization Polari ation


Capacitance effect: positively charged ions resist ion flow eeeElectrode eeNa N + Na+ Na+ Na+ Na+

ClClCl- Cl Cl-

e- e

Electrode-Tissue Interface

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Polarization/Afterpotential Polari ation/Afterpotential


Voltagethatpersistsforatimeafterapacedimpulse Couldcauseoversensing g Polarizationcanrepresent3040%oftotalpacing Polarizationcanrepresent30 impedance i d

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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

V = 5 0 mA x .500 Kohms 5.0 500 V = 2 5 Volts 2.5

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OhmsLa OhmsLaw
Whatwouldbetheimpedanceofa2.5voltsystemwitha10mA currentdrain?

R=V = I

2.5V 10mA

= 2.5V .01A

250

10mAx1A 1000mA .01A

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F ndamentalsofElectronics FundamentalsofElectronics
Energy:Voltagex Currentx Time Energy:Voltagex Currentx

E=Vx Ixt E=Vx Ixt


CurrentinmA CurrentinmA Timeinms Unit=Joule(J)

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46.Matchtheunits:wattsecond a.energy b.power c.capacitance d.currentdrain d d i

joule:unitofenergyorwork henry:unitofinductance(inducedbyamagneticfield) coulomb:unitofcharge l b it f h

34 34.The rateatwhichworkisdoneisis: a. joule unitofenergyorwork b. farad basicunitofcapacitance c. power g d. d coulomb unitofcharge

62.IntheabovefigurelineBrepresentsthe: a. a Chronaxie b. Pulsewidththreshold c. c Kneeofthecurve d. Rheobase

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FundamentalsofElectronics

LowResistance=highcurrentflow

PW

HighResistance=lowcurrentflow

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F ndamentalsofElectronics FundamentalsofElectronics
SystemImpedance
CathodeElectrodeImpedance AnodeElectrodeImpedance PolarizationImpedance PolarizationImpedance TissueImpedance

Typicalrangeforpacingleadimpedance:300toover1200 Ohms h Typicalimpedancerangeforahighvoltagelead1060 Typicalimpedancerangeforahighvoltagelead10 Ohms

Energy,Power,Watts&CurrentDrain gy, ,
Energy:theabilitytodowork;forbatteriesusuallyexpressedin watt watthours1 Energydensity:theenergycontentofabatteryorcapacitorbased onvolumeormass.Forabatteryisexpressedinunitsofwatt onvolumeormass.Forabatteryisexpressedinunitsofwatthrs percubiccentimeterorwatt percubiccentimeterorwatthrspergram1 Power:therateofdoingworkortransmittingenergy,aproductof voltage&currentusuallyexpressedinwatts2 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

CurrentI=V/R C rrentI V/R


Pacemaker4.0V=(I)500ohms P k V (I) h 4.0V/.500Kohms 8.0mA 4.0V/.500Kohms=8.0mA

ICD600830Vi,e.750V=(I)50ohms ICD600 830Vi e 750V=(I)50ohms 75 / 5 750V/.050Kohms=15,000mA 5,

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PacemakerLongevityFactors PacemakerLonge it Factors PacemakerLongevityFactors Longe


BatteryCapacity RateofDrain CircuitEfficiency PacingRate Programmedoutput&PulseDuration %oftimepacing % fti i

45.Thehorizontalasymptoteofastrength durationcurvedefineswhichofthefollowing: g a. charge b. pulsewidththreshold c. rheobase d. chronaxie

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