Yet another reason you're now my favorite KZread channel. I do this for a living as a cardiac electrophysiologist (I implant these among other procedures). You teach me so much with these vids, but here are a few answers to some of your questions: 1) A = atrial; we put a lead there to read the top chamber and pace it if needed 2) Spot on - the cases are always titanium alloys 3) You're right about the hole; it's for attachment, but we suture it directly to the pectoralis major muscle with nonabsorbable suture material (I prefer Ethibond; some others use silk) 4) That buzzer you set off is the "high alert" tone; that model of defib has 2 available alert tones played through a 120dB speaker. When implanted, that sound is only audible in a quiet room. The reasons that can go off are several and programmable and can include any dangerous arrhythmia, prior shock delivered, etc, but always include device malfunction; hence your discovery. What's interesting about this is that the buzzer usually goes off only once daily at a specific time (and repeats daily thereafter until a professional clears it); interesting that you got it to go off so immediately. 5) The high voltage circuitry is via flyback transformer circuit to the very large capacitor (your device is two gen old; a current defib is about 20% circuit, 40% battery, 40% capacitor or so). The voltage is just a hair below 1000V (usually 800-some-odd for that 35J defib you're working on there). 6) You're right about the lithium chemistry of the battery; Lithium Vanadium Oxide I think for that model, but don't hold me to that. The energy density is lower than the lithium fluoride we use for pacemakers but defib batteries are always chosen to delivery VERY high current drain when defibrillation is called for. (More in another comment if needed)

@marekant7776

6 жыл бұрын

doctorgarner Oh wow, that's really something. Thanks for that comment.

@thecrazerkid2146

4 жыл бұрын

Thats very long

If you see those silicon chips on the top, I used to work for the company that made some of those. I was the Sr. sputtering engineer at their clean room. We made the high precision laser trimmed voltage dividers. They were silicon chromium resistors in an array with a TCR of better than 1ppm and very low drift. I am pretty sure we were the only people in the world that figured out the process. It was very difficult. Tons of people use TaN but it only has a sheet rho of around 100(unitless)(distance/distance) while SiCr is around 1000. We made something like a 1000:1 voltage divider at around 1gigohm across with a tolerance of 0.01%. But it also had several other single resistors on it. It was probably one of the smaller ones you see. It was only like 1mm by 1mm. If I remember correctly the stack from the bottom up was silicon(111) - silicon oxide(epitaxial) - SiCr(resistor) - TiW(diffusion barrier) - Aluminum(bonding layer) - Silicon oxide(outer barrier grown with Silane) - super thick Aluminum on the previous Al pads that had been etched through the SiOx layer. Most of the sputtering machines were commercial but our SiCr machine was entirely custom. We used to joke that we needed to sacrifice a goat to get that SiCr process right. As I said before it was very difficult. Once someone accidentally bumped our magnetron and it took me close to a week to get it back right again. This was because it took around 8 hours to perform the process step as it was done it UHV.

@christopherleubner6633

2 ай бұрын

Got some of those from a liquidation auction from Angion. Used them for measuring the HV for several applications, mostly for radiation detectors that needed extremely stable hundreds of V at extremely low currents.❤

BTW, Medtronic is a company valued at $45BN!

Cool. Cochlear implants run about $80K each. And based on the tech involved, I suspect these would be at least a similar cost?

Hahaha how much would you panic if that alarm started going off within your chest cavity!

@nexaentertainment2764

7 жыл бұрын

Reminds me of the "burn my shadow" video. Man now there's a song I haven't listen to in nearly a decade.

Yeah - duct tape probably doesn't work well in gloopy environments. Maybe they have expensive titanium medical grade cable ties?

We recently took a ca. 7 year old model apart. It had similar caps in it, no buzzer but 3 or 4 coils for communications! It was able to communicate to a "basestation" next to your bed to transmit system data while asleep. The basestation had a GSM modem to communicate with the hospital. They had called the "owner" and told him, he had to come in - one electrode had fallen off....the pacemaker detected that, sent it to the basestation and the basestation then "texted" to the hospital :-)

Yes, that's what I meant. Large R&D costs on custom silicon, and the manual production methods and extensive testing and verification are very expensive too. Each line of source code would be independently verified and approved as well. Add in not having a huge volume to amortise your cost over (relative to consumer or other electronics), and that's why any form of implantable medical device is very expensive.

Very cool teardown video!

Thanks for this , one of these saved my life in February this year , I just wanted to know what was in it . My heart stopped and it shocked me and started it again . Thank you very informative

@weeardguy

7 жыл бұрын

Please excuse me for my curiousity, but, did you feel the shock?

@donovandonovan8946

7 жыл бұрын

Hello there , No because when it kicks in you are normally unconscious as i was . Your heart stops no blood round the system to brain , you go out like a light . Thank you Anthony

@weeardguy

7 жыл бұрын

Ah ok. I was just so curious I needed to know ;) I could like understand that the defibrillator senses the problem earlier than the person itself, so it shocks ya before your light goes out ;) There were a few people on television once who (by coincidence) found out that they had the same heart-condition (some heart-rhythm disorder that wouldn't kill you straight away, but would get you into hospital to correct the problem) and all three got an implant like this. I started to get curious when one of them said 'At least I don't have to worry about it right now, I won't feel it anymore if my heart goes out of rhythm' ;)

@weeardguy

7 жыл бұрын

Yeah, I can relate to that last statement ;)

@donovandonovan8946

Жыл бұрын

Cardio Myopathy is the condition . Fist time i had an attack i felt nothing straight out unconscious. The seconded time i had one i tried to remain conscious and yes i felt it , It sound like the sound of an old Bull whip you hear in westerns that mighty crack of the whip ,but the shock was mili seconds but saved my life Twice . Thank you

Ive often wondered what to use to soften epox potting. Thanks Great video. Your teardowns never disappoint!

Mike is the king of teardowns!

A - (right) atrium - top chamber of the heart - low voltage rhythm sense and pacing RV and LV = Right & Left ventricles - low voltage sense and pacing SVC - Superior vena cava (big vein) - Defib electrode RV - right ventricle - seperate defib electrode Some of these ICDs use the case of the device as a reference electrode for defib - something to do with producing a better bipolar waveform. I think that's what "active can" refers to. Battery is a special lithium silver vanadium cell.

6:20 if your pacemaker starts making noises you’re supposed to call your cardiologist, they have internal fault detection systems and if they determine a malfunction they go off like this

I love watching your videos always so interesting tearing down and figuring things out

Real interesting lecture in the world of the defibrillator.. Thanks Mike...

The silicon is big because it is a large features size. For example 1 um instead of 65 nm: 16 times the widths and length. And that is needed for low power. The speed goes down but the leakage current goes down as well. And these need to run very long on a battery. The large feature size (thinck insulation etc) also allows to have power circuits with the processing. Maybe the processing is dedicated hardware, and the CPU only comes online every so often to readjust thresholds etc.

Great teardown as always Mike! This was an interesting item, well presented!

Happy New Year Mike, keep up the the GREAT work mate!

great job, glad you had the patience mate

Cap is needed as you'd need to pull too much current from the battery. It's also safer as the cap limits the total energy that can be delivered.

The user hears it kind of "internally" but people around him can hear it if they listen closely enough. I remember my friend's beeping when I was playing with some sort of magnet toy (rare earth) near him. It's designed to disable its defibrillator functions (but not the pacing functions) in emergencies.

It was recalled! medtees.com/ICD_Recall_Info.html Seems you can just put a magnet over it and get a self test beep.

The one s you refer to on tv were having a pacemaker fitted , very small device for slow heart beat "feeling faint " Elton John had one fitted . A defibrillator is a whole new thing, these are life saving devices for heart failure .

Interesting side-note, the two-tone beep is usually an alert for 'impedance change detection'; some people have experienced this when insulation around one of the implantable leads has broken down

Wow,that's some gorgeous engineering inside of that small thing.

A relative had one of these fitted which had remote monitoring. It had a base station that was connected to the phone line. The defibrillator would send out a signal to the base which would phone home to say that it had delivered a defibrillation, along with some stats. They could then call him in to hospital as needed.

That's the best pinout diagram I've ever seen.

Batteries for pacemakers/ICD:s are not rechargeble. Instead the device is very energy efficient and the battery is very high capacity. St. Jude has a department dedicated to the development of batteries. Once a pacemaker/ICD is about to run low on battery it is replaced with a new one (once every 10 years or so). The replacement is a pretty minor operation, since only the can is replaced and not the leads. That's why the leads are attached with connectors and not permanently attached to the can.

Had a bunch of batteries and stuff for these a while back. The SVO batteries make awsome memory back up batteries that also need to supply a lot of current intermittantly fof emergency use devices.❤

Crumbs, those microscope zooms are quite something! Fascinating stuff.

The best way to understand our universe is with a good lamp and a screw driver.

awsome video

Great video!

Hi Mike. I have in some situations been able to shield fairly low frequency magnetic fields (10s of kHz) using thick copper. The eddy current losses eventually (if the material is conductive enough and thick enough) attenuate the field. Of course, for DC, the only things that can shield that are high permeability materials like mu-metal or superconductors.

Very old ones (~40 years ago) used plutonium cells as that was one of the only cell chemistries available at the time that had a sufficient lifespan and was small enough to fit in the pacemaker housing.

another great video!

It was crying and you killed it!

It's magnetic coupling, not electrostatic - Faraday cages only protect against the latter. There will be some eddy current losses, but as the case is not magnetic, some field will get through.

That's a neat piece of hardware

Thanks for a great and informative video. Four days ago I had a Metronics EVERA XT DR DDBB1D4 installed, it is a combined two wire model, and I was curious about the gubbins under the good. My manual says the error noise only goes off for a set time every day to alert the wearer (me) that action is required or that action has been taken. Then I hook it up to the Remote Carelink Monitor device and call my hospital who can analyse it remotely. They killed the VP using a Remote Monitor in a Homeland episode taking some technical truth and adding some artistic license, it made for good TV. Cheers Nigel

That is amazing mate. Always wanted to see what one looked like. How do you get hold of these things mate?? I can never find anything like this around derby lol. Thanx for sharing mate, THUMBS UP*

"previous owner"?, "biological goo"? You are not supposed to dive into hospital dumpsters!!!

@nexaentertainment2764

7 жыл бұрын

As I understand it sometimes you're allowed to keep these things, and they sometimes end up on eBay. Or Mike may have some friends that work at a hospital and are free to supply him such things. As for non used ones, they're usually display, or 'practice' units. Or surplus, afaik sometimes hospitals/suppliers will have hundreds of these laying around, and a new model comes out making them functionally obsolete, so they dump them all. Usually destroyed and scrapped, but sometimes some will find their way onto ebay.

thanks for posting, I kept mine after 10 years implanted because it gave me a shock at 6.12 in the morning and after one therapy the protocol is to change the model and I told the surgeon that I wanna it back, that is mine, put it in my surgery robe. he did. now I can see what is inside this souvenir and yes the alarm goes on usually at 11 am and 11 pm. even my dog reacted to this specific noise. how the shock was, really normal the same level of a shock from say electric household lamp, but shorter, anyway I was sleeping turned around and went back to sleep, then at lunch I went to the cardiac hospital to report incident, normal life goes on I have a new one 3 cables and bigger since 2012 = feb. 2017 no incident.......those are made here in Puerto rico- medtronics

Cool! For anyone wondering, the serial number sticker on the capacitors reads "E0309447-014", in "DATA_MATRIX" format.

LOVE YOUR VIDEOS!! AWESOME!!! ;-)

That is one fascinating bit of tech. I read that some of rhe more recent designs which have comms have been hacked though.

I ended up opening my friend's old Guidant (Boston Scientific) Vitality AVT Model A155. I wasn't very graceful in my attempt, but I only BARELY nicked the battery and it didn't catch fire :D . It is WILDLY different than the one Mike opened up which is coincidentally probably identical to the FIRST pacemaker my friend got in 2005. This Guidant model was his second and was installed in 2007 and removed in 2009. He's on his fourth! I'll post pictures when I don't have a splitting headache.

I have a pacemaker/implantable defibrillator that belonged to a close friend who has since probably had it replaced twice (battery drain). It's elsewhere right now, so I don't remember the model and whether or not it's different enough to the one you tore down to warrant another tear-down, but I'll grab it this week and take a look. I'm not sure that I have the patience to decapsulate it myself. Thanks for this video - I now better appreciate why these things cost an astronomical amount! $100k..

I have an old TENS (transcutaneous electrical nerve stimulation) device if you're interested. To my knowledge, the device is probably 20 years old and still works.

Maybe but the limited range means it isn't a significant risk. ISTR reading some ridiculous nonsense a while ago about the possibility of malware transmission between implanted devices.

the older type ones were a bit "jumpy " and tended to shock at the slightest miss beat ,but the new ones also have a Pacing program in them and let the heart try and realign itself first , then if it can`t ,first slight shock is given (very mild wont feel anything ) this is "pacing" ,then if you "blackout" a full shock is given to re establish normal heart rhythm . people watching will see your body jolt as the shock kicks in , but the person with the defibrillator should feel nothing only a bit "groggy " when he/she comes around . People holding on to or touching the person at the time will NOT receive a discernible shock of any sort .

@davidtyra6243

6 жыл бұрын

Anthony Fox does the devices save data within the unit it’s self if active

I have a crt-d implant and that beeping noise is the ‘battery low’ audible indicator

Insight from one of the original designers would be incredibly interesting!

nice teardown, i have one of those laying around

That mystery chip looks a lot like a thumbnail pic that Medtronic is using to advertise their built-in self-test circuits. It seems like a plausible description for why it's laid out the way it is.

What batteries do you change when they are bad? anything else to replaces in defibrillators that fail common?

I don't know much about ICDs but I'm guessing the battery isn't rechargable? Where in the body are they implanted, and how often do you need to replace them?

Could that potting compound be the same stuff they use to make normal IC's with? In that case you probably need to use fuming nitric acid like in Ben Krasnow's video.

OK, now see if you can put it back together again. How long did this teardown take? Two months?

I read something about batteries failing short - apparently accompanied by a "warm feeling"...

the malfunction/magnetic interferance beep is fairly loud. the low battery alert is more subdued. i live 2 houses from a school and could not tell where the beeping was from - they are always making noise at the school, and my "borg implant" rang at 9am. it wasnt until i was away that i realised it was from inside me. its not as obvious to tell as you may think. the more serious alarm gets your attention fast!

I've got a medtronic device (not a pacemaker) which cost a few thousand, pretty surprised to see inside this being so advanced, mine is pretty simple in comparison (I wouldn't think any custom chips). It also has a wireless data transfer that is always on, with a ~15 metre range and communicates with a PC, another medical device from another company and a remote control so it wouldn't surprise me if malware does start to appear on medical and medtronic devices.

Yes please!

Yesterday 1/25/2021 I had a device fitted. Medtronic Claria MRI Quad DF4. I'm hoping it's going to be my friend. 👍🏼

I LOL'd when it's alarm went off.

With large devices comes high capacitance, too! I guess the trade-off involves how long your chip spends doing next to nothing. If you spend a lot of time doing very little, leakage may dominate.

My Toothbrush battery is recharged by induction coil. Why not recharge the battery by induction? Gas release from the battery?

You can have my pacemaker when i´m done with it! But last time it was checked it still had 7 years left on the battery..

It's kind of creepy that this was once inside a living guy who obviously doesn't need it anymore because of being dead.

6:08 - Have a heart attack, I think.

@QOTSAPT

6 жыл бұрын

LOL

Can you put it back together now?

That CPU looks like an embedded 8052 core, like in a credit card, just a bigger feature size. You can basically consider this to be a single multichip IC, as that potting is probably the same one used on conventional chip packages. Best way to have removed it would have been a mix of HF and fuming nitric acid in a big well ventilated area with regular washing in acetone to remove the degraded stuff. No epoxy or underfill left, just the bare chips and the insides of the caps and any ceramics.

Hey! i was wondering if you could tell me about my pacemaker that i have? unfortunately i do not know what model i have but Had 3 pacemakers and this is now my forth one. I received it Last Year June. I do know that i do not have one that can go through a metal detector but there is one like mine that can... sorry i dont know much about it...

how in the world did you get something like that to play with

I imagine friends or viewers send them his way. My friend gave me his old pacemaker just because. I haven't dared open it, though, because I lack patience. He's had three, but a more "serious" hospital replaced it the most recent time and wouldn't let him keep the "medical waste".

Actually it may well be a serious risk. There was a presentation at BlackHat recently that showed it was entirely possible to use a high-power transmitter to interface with at least one such device remotely, simply by "pretending" to have heard the device's response and sending new configuration data using the (rarely changed from default) pin-code. They demonstrated that the device was capable of outputting hundreds of volts on demand. Nasty stuff.

Do you have a morgue supplier?

If your still interested in pacemakers etc. We have loads at work being an undertaker, Quite a number that use an atomic battery aswell ;)

*clip* *clip* BEEP BORP BEEP BORP OH FUCK IT'S ALIVE

They beep when theres a fault. or the battery is low.

I've already done two - check my medical playlist

Where do you get this stuff from?

Mike, Thanks for the video I do enjoy them.. just one suggestion.. please raise your voice when look in at small bits.. seems like your voice goes so low its hard to understand at times.. other than that.. thanks for the hours of entrainment...

I took one of those apart as well, but I can't find the photo's anymore... :( I had exactly the same unit from my uncle.

All of those chips are silicon-on-insulator technology. They are manufactured using the same techniques used for space electronics. They are fully radiation hardened.

I bet you that coil is. Oh and I found out that these things can be configured in a large number of ways with programmable output between rouughly 2.5v and 7.5v What amazes me most is how little power they use. Would you dare design one?

Maybe they cable tie it into the ribcage? That made me chuckle :)

Battery is non rechargeable lithium, normally will be changed out every 10 years ( leave leads in and just connect new one, as this is on the side under your ribs and easy to get to, no splitting you like a slaughtered animal again. This will trigger airport detectors. the coil is for the doc to get stats on when it operated, how much, how long, rates and such, stored in the big RAM chip, and read out with a coil held over it.

just goes to show we need computer diagnosis. a decision maker that knows all cases and can keep it all straight unlike a doctor that just wants the problem to go away..

Can you imagine going through an airport and having your pacemaker start to beep.

I don't understand how the induction loop works INSIDE the titanium can. Doesn't that act like a faraday cage?

It appears that there is a nice amount of gold plated bits that the wires are welded to.

So who said Tantalums were unreliable?

Maybe the chips are massive because they're not as densely populated as a regular IC is. Either it's some really old, tried and tested bit of processing or the ICs are full of redundancy. You probably don't want a pacemaker to 'crash' or 'go a bit mad' like processors can do sometimes. Poking the reset button with a paperclip wouldn't be that convenient ;-)

Good old fashioned RS screwdriver :)

lol @ alarm, interesting it's still active!!

Typically, regulatory requirements need a calculated failure rate based upon statistical analysis of failure rate of component parts. Some parts (like software) are taken to have a failure rate of 100% for the purposes of analysis, so for something complex like an ICD - the software will be backed up by logic that will provide failsafe operation. I believe NHS cost for one of these devices is about £25k + VAT.

Yeh, they do cable tie it to the rib cage.

A mate's dad has just had one of these and after a few days it went off bleeping. Turns out it was implanted as a 2-wire configuration and the surgeon uploaded a 3-wire programme by mistake. :-/