How does a pacemaker work? When was the pacemaker invented, who invented it? We are citing an article that answers these questions.
How does the pacemaker work, can it be hacked?
Even this term “pacemaker”, I think, is an indication that we live in the future. however, the steps taken to develop the pacemaker date back to 1889. I will talk about the history of the work later. Now to understand how the pacemaker works, we first need to take a brief look at how the heart works.
Our heart, soul, and brain are our most precious organs — some of them are more valuable because these two organs are not working properly, don’t look at them.
Our heart, which is responsible for pumping the blood that will transmit the vital needs of the body to the most distant cells, continues to do its duty from the 5th week of our conception until we die. As we doctors say, the thorax, that is, it extends from the middle of our breast to our left breast. that is, it is not attached to our left side as some of you imagine. We call it our most precious organ, that’s why it is located in a part of the body that is relatively hard to reach from the outside, under the protection of the chest.
Our heart is roughly divided into two parts: the right side where the contaminated blood is collected and sent to the lungs – our right – and the left side, where clean blood is taken from the lungs and pumped into the body. The two rooms at the top of these two parts are called atrium, in Turkish it is called auricle. Contaminated blood filled with carbon dioxide from the body fills the right atrium, and clean blood from the lung fills the left atrium. From here, the contraction of the auricles and the blood is transmitted to the lower chambers of the heart by means of two separate valves. These chambers are called ventricles, or ventricles. You can remember how our ears are on top, our belly is on the bottom, just like that.
The blood filling the ventricles leaves the heart to be cleansed from the right side by contraction of the ventricles, to carry clean blood to the lungs to be filled with oxygen again, and to the body from the left side.
The electrical signals emanating from a group of specialized cells located above the right ventricle of the heart initiate all this contraction. this point is called the sinoatrial node. this is the pacemaker of the heart in English. They translated it into Turkish as a producer of beat, but rhythm keeper, I think, would be a better term. because the activity in this node determines the “speed” of the heart, our pulse. I also used the word pacemaker deliberately because the English of the pacemaker is also referred to as pacemaker or artificial, artificial pacemaker.
Under normal circumstances, the more signals per minute from this sinoatrial node, the more or less your heart beats. In healthy adults, this is between 60 and 80 beats per minute. Sometimes it can be lower and sometimes higher, so don’t panic. If you do not have a health problem, being around 60 is usually a sign of a better cardiovascular system, cardiovascular health. On the other hand, the heart rate above 80 when resting may be mainly due to stress, physical laziness, consumption of caffeine-containing beverages or smoking.
This signal first contracts the upper chambers of the heart, namely the auricles, and then contracts the lower chambers, or ventricles, with a little delay. If this delay does not occur, the heart cannot perform its task efficiently due to the pressure generated in the opposite direction. At work, pathological situations that disrupt this harmony in the heart, that is, normal physiology and healthy body situations may occur. Due to various reasons, the heart may start not to beat fast enough, disrupt its rhythm, or fail to generate sufficient number and strength of signals. At this point, pacemakers come into play.
While there are models that are preset by the doctor and are set to provide a constant beat, most of the ones used today are programmed to send additional signals when they notice that the heart deviates from its normal rhythm or to interrupt the signals it sends. There are also models designed to automatically deliver electroshock to the heart when it detects serious rhythm disturbances in which the heart will enter a crisis state, possibly with a fatal outcome.
So how is the pacemaker placed?
Small electrodes are placed where the signal in the heart will be initiated by passing through the veins with very thin conductive cables. Depending on the need, some can be used to generate a signal starting only from the auricles, while some are placed in the auricles to send an electrical signal for contraction. The other end of these cables is then connected to the pacemaker device that will generate the electrical signal. If pacemakers are to be used temporarily, they can be kept outside of the body, or they are placed under the skin through a slit to be opened slightly above the left or right breast of the patient for permanent use. The subcutaneous places are generally above the muscles, and under the subcutaneous fat tissue to be a little more protected. These procedures can be performed when the patient is under general anesthesia or can be handled with only local anesthesia and a little sedation, and sedatives are given to the patient.
Today, models in the size of a small capsule that will be placed directly into the heart and do not use cables are being developed. They are still in the process of settling their minor impairments such as getting out of where they are and drilling right and left. Wired or wireless pacemakers are coated with titanium to seal, which does not interact with the body.
Lithium-ion batteries of pacemakers have a life of 5-10 years. Devices close to their end need to be replaced. this change process takes much less time as it does not require new cable “laying”. patients can usually go for a check-up every 6 months, but now, in current models, the status of the device can be checked remotely.
After the pacemaker is inserted, it can be programmed externally by the doctor and / or the technician. However, this external intervention allows, theoretically, the pacemaker to be “hacked”. It has been practically proven that pacemakers have hackable security vulnerabilities. However, this requires access to the pacemaker at a close distance. There is a possibility that the pacemaker can be hacked remotely via an amplified antenna.
Since strong magnetic fields can also damage the pacemaker, such environments and devices should be avoided. Magnetic resonance devices are the leading ones. Earphones with small magnets inside may also have negative effects if they are placed directly on the pacemaker. However, among the new generation pacemakers, it will be conditionally suitable even for MR.
Apart from that, people with pacemakers can lead a normal, active life, and can do sports in consultation with their physicians. However, activities that may damage the pacemaker by direct contact should be avoided or these works should be done with equipment that will protect the device.
If we look at the history of heart science
It was reported for the first time in 1889 that this contraction could be achieved with an external electrical stimulus given to a human heart in asystole, that is, the atria that would pump blood to the body, and even this process could be repeated 60-70 times per minute. The inventor of the present invention is Scottish physiologist John Alexander William.
After proving that the heart can be operated by “poking” with electricity from the outside, many scientists have carried out studies in this area. In fact, a stillborn baby in Australia in 1928 was brought back to life and kept alive thanks to this type of device. However, due to the sensitivity of the subject, the researches conducted between 1930 and the end of the second world war were not published much. in a way they raise the dead.
In 1950, a Canadian team devised a system that would pass through the skin and send electrical signals to the heart. However, this rather large device is also not practical as it requires the use of an electrical socket in the wall. More and more small, rechargeable batteries are used, but they are still not very portable. In my opinion, a 45-pound pacemaker using a car battery developed in Colombia in 1958 is the most interesting of all.
However, in the same year, with the invention and use of silicon transistors, the first portable, or rather wearable pacemaker, was invented in America. The importance of science, leadership in science, can be seen just by looking at this example. 1958 was the year when the first pacemaker embedded under the skin was put into practice. This job is invented by Rune Elmqvist at the Karolinska Institute in Sweden, not in America, and is attached to a patient named Arne Larsson by Ake Senning.
Arne Larsson will replace 26 pacemakers over the remaining 43 years. The main reason for this is that old batteries need replacing more frequently, up to the lithium-ion batteries introduced in the second half of the 1970s. Larsson migrated from this world in 2001, at the age of 86, living longer than the Swedish surgeon who invented the modern pacemaker and first implanted it.