MUCLecture 2022 52033550

Physics of Medical Devices
Eleven lecture
Cardiac Defibrillators
Msc. Eman Ahmed
Third Stage
Department of medical physics
Al-Mustaqbal University-College
2021- 2022
1
Introduction
A defibrillator is a device that sends electrical energy, or shock, to the
heart. The aim of using a defibrillator is to treat cardiac arrest. The need
for this generally arises when the patient has ventricular fibrillation or
ventricular tachycardia, which are life-threatening arrhythmias that occur
when contraction of the ventricles become abnormal. Defibrillators have
electrocardiogram (ECG) leads and adhesive patches (or paddles). The
adhesive electrodes are the patches placed on the patient’s chest that
deliver the electric shock.
History
 First Demonstration; 1899, Prevost and First Demonstration; 1899,
Prevost and Batelli Batelli, Physiologists from , Physiologists from
 Switzerland. Switzerland.
 ƒ Small charges cause ventricular fibrillation Small charges cause
ventricular fibrillation
 ƒ Large charges reverse the syndrome. Large charges reverse the
syndrome.
2
 ƒ Claude Beck, 1947, Western Reserve University Claude Beck, 1947,
Western Reserve University
 ‘Heart too good to die Heart too good to die”
 ƒ 14 Year Old Boy saved from 14 Year Old Boy saved from
congenital heart disease by congenital heart disease by
 defibrillation with procaine amide heart medicine. defibrillation with
procaine amide heart medicine.
 ƒ AC Current 110 AC Current 110-240 V →300-1000 V; Damage to
Cells; Bulky ; Damage to Cells; Bulky
 Transformers Transformers
 ƒ Dr V. Eskin and A. Klimov in Frunze , USSR 1950 in Frunze ,
USSR 1950’s; Closed Chest s; Closed Chest
 Method; AC >1000V
Types of Defibrillators (AC and DC Defibrillators)
Two types of defibrillators are showing below.
1. AC defibrillators
2. DC defibrillators
3
AC Defibrillators
An AC defibrillator is the oldest and simplest type. The construction of AC
defibrillator is such that appropriate values are available for internal and
external defibrillation. In AC defibrillation, a shock of 50 Hz a.c frequency is
applied to the chest for a time of 0.25 to 1 second through electrodes. The
procedure of applying electric shock to resynchronize heart is known as
Counter shock.
Defibrillation continues until patient responds to the treatment. An AC
defibrillator consists of a step-up transformer with primary and secondary
winding, and two switches. A.C supply is given through switches and fuse to
primary winding of the transformer. The timing circuit is connected with
switch, which is used to preset the time for the defibrillator to deliver shock
to the patient.
4
For safety reasons, secondary coil should be isolated from earth to avoid
shock. For internal fibrillation voltage values between 60 V to 250 V is
applied. To produce uniform and simultaneous contraction of heart muscles
large currents are used for external defibrillation. However, this results in
skin burn under electrodes and violent contraction of heart muscles. It also
results in atrium fibrillation and stops ventricular fibrillation.
DC Defibrillators
DC defibrillator does not produce side effects and produces normal
heartbeat. Ventricular fibrillation is avoided when high-energy shock is
passed through discharging capacitor that is exposed to heart or chest of
the patient. DC defibrillator consists of auto transformer T1 that acts as
primary of the high voltage transformer T2.
A diode rectifier rectifies the output voltage from T2. It is connected to
vacuum type-high voltage over switch. At position A, switch is connected
5
to one end of the capacitor. When connected in this position capacitor
charges to a voltage. A foot switch present on the handle of the electrode
is used to deliver shock to the patient.
Now the high voltage switch changes it position to B that makes the
capacitor to discharge to the heart through electrodes. To slow down the
discharge from the capacitor an inductor L is placed in one of the electrode
lead. This L induces a counter voltage that reduces the capacitor discharge
value.
Waveform change
Until the mid 90s, external defibrillators delivered a Lown type waveform
(see Bernard Lown) which was a heavily damped sinusoidal impulse
having a mainly uniphasic characteristic. Biphasic defibrillation alternates
the direction of the pulses, completing one cycle in approximately 12
milliseconds. Biphasic defibrillation was originally developed and used
for implantable cardioverter-defibrillators. When applied to external
6
defibrillators, biphasic defibrillation significantly decreases the energy
level necessary for successful defibrillation, decreasing the risk of burns
and myocardial damage.
Ventricular fibrillation (VF) could be returned to normal sinus rhythm in
60% of cardiac arrest patients treated with a single shock from a
monophasic defibrillator. Most biphasic defibrillators have a first shock
success rate of greater than 90%.
Implantable devices
A further development in defibrillation came with the invention of the
implantable device, known as an implantable cardioverter-defibrillator (or
ICD). This was pioneered at Sinai Hospital in Baltimore by a team that
included Stephen Heilman, Alois Langer, Jack Lattuca, Morton
Mower, Michel Mirowski, and Mir Imran, with the help of industrial
collaborator Intec Systems of Pittsburgh. [39] Mirowski teamed up with
Mower and Staewen, and together they commenced their research in 1969.
However, it was 11 years before they treated their first patient. Similar
developmental work was carried out by Schuder and colleagues at
the University of Missouri.
The work was commenced, despite doubts amongst leading experts in the
field of arrhythmias and sudden death. There was doubt that their ideas
7
would ever become a clinical reality. In 1962 Bernard Lown introduced
the external DC defibrillator. This device applied a direct current from a
discharging capacitor through the chest wall into the heart to stop
heart fibrillation.[40] In 1972, Lown stated in the journal Circulation —
"The very rare patient who has frequent bouts of ventricular fibrillation is
best treated in a coronary care unit and is better served by an effective
antiarrhythmic program or surgical correction of inadequate coronary
blood flow or ventricular malfunction. In fact, the implanted defibrillator
system represents an imperfect solution in search of a plausible and
practical application."[41]
The problems to be overcome were the design of a system which would
allow detection of ventricular fibrillation or ventricular tachycardia.
Despite the lack of financial backing and grants, they persisted and the
first device was implanted in February 1980 at Johns Hopkins Hospital by
Dr. Levi Watkins Jr. assisted by Vivien Thomas. Modern ICDs do not
require a thoracotomy and possess pacing, cardioversion, and
defibrillation capabilities.
The invention of implantable units is invaluable to some regular sufferers
of heart problems, although they are generally only given to those people
who have already had a cardiac episode.
8
People can live long normal lives with the devices. Many patients have
multiple implants. A patient in Houston, Texas had an implant at the age
of 18 in 1994 by the recent Dr. Antonio Pacifico. He was awarded
"Youngest Patient with Defibrillator" in 1996. Today these devices are
implanted into small babies shortly after birth.

MUCLecture 2022 52033550

Uploaded by

Copyright:

Available Formats

MUCLecture 2022 52033550

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

MUCLecture 2022 52033550

Uploaded by

Copyright:

Available Formats

Physics of Medical Devices

Msc. Eman Ahmed

A defibrillator is a device that sends electrical energy, or shock, to the

ventricular tachycardia, which are life-threatening arrhythmias that occur

when contraction of the ventricles become abnormal. Defibrillators have

electrocardiogram (ECG) leads and adhesive patches (or paddles). The

deliver the electric shock.

 First Demonstration; 1899, Prevost and First Demonstration; 1899,

Prevost and Batelli Batelli, Physiologists from , Physiologists from

 ƒ Small charges cause ventricular fibrillation Small charges cause

 ƒ Large charges reverse the syndrome. Large charges reverse the

Western Reserve University

 ‘Heart too good to die Heart too good to die”

congenital heart disease by congenital heart disease by

 defibrillation with procaine amide heart medicine. defibrillation with

procaine amide heart medicine.

 ƒ AC Current 110 AC Current 110-240 V →300-1000 V; Damage to

Cells; Bulky ; Damage to Cells; Bulky

 ƒ Dr V. Eskin and A. Klimov in Frunze , USSR 1950 in Frunze ,

USSR 1950’s; Closed Chest s; Closed Chest

Types of Defibrillators (AC and DC Defibrillators)

Two types of defibrillators are showing below.

external defibrillation. In AC defibrillation, a shock of 50 Hz a.c frequency is

procedure of applying electric shock to resynchronize heart is known as

Defibrillation continues until patient responds to the treatment. An AC

defibrillator consists of a step-up transformer with primary and secondary

primary winding of the transformer. The timing circuit is connected with

shock. For internal fibrillation voltage values between 60 V to 250 V is

applied. To produce uniform and simultaneous contraction of heart muscles

results in atrium fibrillation and stops ventricular fibrillation.

heartbeat. Ventricular fibrillation is avoided when high-energy shock is

passed through discharging capacitor that is exposed to heart or chest of

the patient. DC defibrillator consists of auto transformer T1 that acts as

primary of the high voltage transformer T2.

A diode rectifier rectifies the output voltage from T2. It is connected to

vacuum type-high voltage over switch. At position A, switch is connected

charges to a voltage. A foot switch present on the handle of the electrode

is used to deliver shock to the patient.

capacitor to discharge to the heart through electrodes. To slow down the

discharge from the capacitor an inductor L is placed in one of the electrode

(see Bernard Lown) which was a heavily damped sinusoidal impulse

having a mainly uniphasic characteristic. Biphasic defibrillation alternates

the direction of the pulses, completing one cycle in approximately 12

milliseconds. Biphasic defibrillation was originally developed and used

for implantable cardioverter-defibrillators. When applied to external

level necessary for successful defibrillation, decreasing the risk of burns

and myocardial damage.

Ventricular fibrillation (VF) could be returned to normal sinus rhythm in

60% of cardiac arrest patients treated with a single shock from a

monophasic defibrillator. Most biphasic defibrillators have a first shock

success rate of greater than 90%.

A further development in defibrillation came with the invention of the

implantable device, known as an implantable cardioverter-defibrillator (or

ICD). This was pioneered at Sinai Hospital in Baltimore by a team that

included Stephen Heilman, Alois Langer, Jack Lattuca, Morton

collaborator Intec Systems of Pittsburgh. [39] Mirowski teamed up with

developmental work was carried out by Schuder and colleagues at

the University of Missouri.

the external DC defibrillator. This device applied a direct current from a