How pacemakers work

The Economist
The Economist
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Published 2010-04-21
How pacemakers work. Animated explanation of the mechanics of the human heart, and the devices that can assist it

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Implantable pacemakers and defibrillators are devices that apply electric shocks to maintain the rhythm of the heart and, if necessary, restart it.

As the technology improves and the list of treatable conditions grows, the number of devices being implanted is increasing steadily and now exceeds half a million a year.

The heart is made up of four chambers; two atria and two ventricles. On each side the atrium is connected to the ventricle by a one-way valve. Blood is pumped as these chambers contract and relax in turn.

The beating of a healthy heart is regulated by electrical impulses. The sequence begins as the atria fill with deoxygenated blood from the body on the right and oxygenated blood from the lungs on the left. An electrical signal from the sinoatrial node then causes the atria to contract, forcing blood into the ventricles. The electrical signal is then picked up by the atrioventricular node and directed into the Purkinje fibers in the ventricle walls, causing the ventricles to contract, and the blood is then pumped through the pulmonary valve on the right to the lungs, and the aortic valve on the left to the rest of the body. These valves close and the cycle then restarts.

When the sinoatrial node fails to function correctly an artificial pacemaker can be fitted to help regulate the heartbeat with small evenly timed electric shocks. This involves implanting electrodes into one or more of the heart's chambers, by inserting leads into a vein near the collarbone and implanting a device called the generator just under the skin.

For more severe heart conditions an implantable defibrillator or ICD can be used which is also capable of sensing a stopped heart and delivering an electric shock powerful enough to restart it.

For some conditions an even more sophisticated device called a CRT ICD can be implanted. This uses a third lead inserted into the left ventricle to resynchronize the ventricles when necessary. However, all these leads can cause problems of their own. Patients with ICDs have a 20% chance of a lead failure within 10 years and replacing leads can require open-heart surgery in about 2% of cases.

This has resulted in several efforts to develop new pacemakers that do not depend on leads inside the heart. One design, the subcutaneous ICD, places the lead just outside the heart under the patient's skin.

And wireless designs are now being developed that may eventually do away with the need for leads altogether.

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All Comments (21)
  • @dexedr1ne
    Wow what a time in human evolution to be alive.. and it keeps getting better!
  • @Drop0fHoney
    I appreciate these kind of visual explanation. My granddad just got one and I didn’t quite understand how it works. Ty for making these ❤️
  • @irishman4671
    I've had one in for two weeks and my dizziness and constant passing out has stopped completely. Guess it's doing what it should. Having it put in was a breeze and minimal pain after.
  • @krazylia
    Amazing explanation. Learned everything within 2:51. Thanks.
  • @TheSanchit96
    Hey Thanx A Lot !!! Such A GR8 VIDEO !!!!!! very informative !!!
  • @commonman80
    Boston Scientific Dual Chamber Pacemaker. Got one now. Works Great so far. Only about the size of 3 stacked Quarters. I just have to remember that I have it at times. Like when I'm lifting, or working on my car. Or walking through a Metal Detector.
  • @robertryan6782
    I would rather the title hadn't have said 'pacemakers' when defibrillators are different - I have one myself and been shocked twice.