6 ms·

It sounds like you have quite a bit of knowledge on the subject. I had to get a pacemaker a couple years ago, and am an embedded engineer. I hope to live anothe

It sounds like you have quite a bit of knowledge on the subject. I had to get a pacemaker a couple years ago, and am an embedded engineer. I hope to live another 50 years at least, so this is an interesting subject for me. Maybe my cardiologist is just trying to make me feel good, but he says my leads will likely last 30-50 years. Intuitively that seems unlikely, but we'll see. It's got to be one of the most engineered cables in existence. The leadless pacemakers are indeed a technical marvel, but they aren't yet nearly as feature packed as shoulder implanted devices. They'll keep your heart from stopping if your nerves are flaky from time to time, but they don't have the energy storage to do much more than that. Mine monitors every single beat my heart takes, and automatically reports issues to my doctor via BLE. (Is bluetooth more or less scary than radioactive isotopes mounted in your body?) For about 8 months, my AV nerves were completely broken, and the pacemaker paced my ventricles 100% of the time. It was a nearly perfect drop-in replacement for the failed nerves. A leadless pacemaker wouldn't have had nearly the same performance. My nerves eventually started mostly working again, and now I'm on track to have a battery life pushing 15 years. It would of course be great for the technology to advance even more over the next decade. Since my nerves mostly healed, a leadless device with a 30+ year battery life would be a nice replacement. With a shorter battery life, I don't really want to be collecting them in my heart (they don't plan to remove leadless pacemakers when they die.) I'm hoping by the time my current device is worn out, it will have logged enough telemetry for me to convince my cardiologist that I don't need a pacemaker at all, though.

samstave 4y ago
- sgtnoodle 4y ago
  Lol. I've certainly already made the joke that embedded systems are dear to my heart. I'd consider working a few years at a place like Medtronic just to see what I can contribute, but on the other hand I hear there's roughly a 2:1 ratio between requirements and lines of code. Going through airport security is fun just because the TSA agents overreact as if the metal detector is going to kill me.
  - samstave 4y ago
    DYSTOPIAN OUTCOME: /u/sgtnoodle has accepted a great job with MedTronic, little does he know, that as a QA process embedded engineer, his duties require him to monitor various labs - including the PENTEST/AGGRESSIVE attack lab... but the anechoic chamber contract was low bid - and has leaks... As he walks by the lab, checking his tablet for his various checklists... there is a leak. A deadly leak... As he rounds Corridor-4A toward his desk, the leak hits him. As a Class-I Mk2 Embedded engineer, he was susceptible to the RF attacks... We only found him after the alarm sounded that he badged through Door X1A, but never made it to Door TR3B where his lab was... Cardiac failure due to failed electro-stim documented as cause of termination of employment.
- LastTrain 4y ago
  You are getting downvoted for the conspiracy theory aspect of your post and for throwing shade on a guy with the pacemaker. If you care about being liked, say likeable things.
  - samstave 4y ago
- noisy_boy 4y ago
  Yeah this knee jerk downvoting sucks. Have an upvote.
guhidalg 4y ago
My heart sank when you mentioned a BLE-enabled pacemaker. Has technology gone too far? /s
- melq 4y ago
  It sounds like the bluetooth functionality is only there for telemetry.
  - samstave 4y ago
    An interesting thought would be to have a nano-lead down the arterials to the wrist, where an external telemetry relay-watch could read the signals, and have the BLE device top dermal. (apple watch) eliminating RF/BLE bullshit from talking to the pacemaker.
    - sgtnoodle 4y ago
      Being pragmatic, that sounds way worse than just having a little ceramic 2.4ghz antenna and some extra silicon potted into the device!
      - samstave 4y ago
        https://www.dailymail.co.uk/news/article-2379009/Barnaby-Jack-dead-days-demonstrate-kill-fitted-pacemaker.html https://www.dailymail.co.uk/news/article-2379009/Barnaby-Jac... - Oops - I didnt realize you were same poster from other comment
        sgtnoodle 4y ago
        I don't think my particular pacemaker has the necessary circuitry to generate more than 5V, in pulses less than a few milliseconds. The voltage doesn't really matter much to the muscle. If you got in you could probably put the leads into single-ended mode (so that there's more current path to cause mayhem) and pace my atrium and ventricles at 210bpm, and effectively give me a seizure. I can't imagine it would kill me before an EMS arrived with a magnet? Perhaps a more nuanced attack would be to somehow use all the configuration parameters to intentionally bias the pulses so that there's net charge going into the muscle. Over a long time that would cause tissue damage. If someone wanted to kill me overtly, a gun would be less work. A pacemaker malfunction that bad would be thoroughly investigated, and would be fixed in new devices within a year or two.
alphaoverlord 4y ago
If you have complete AV block, a leadless pacemaker is less good than one with multiple leads, since it allows pacing multiple chambers and maintaining synchrony between A and V.
- animatedb 4y ago
  There are now leadless devices that communicate with each other using RF.
  - sgtnoodle 4y ago
    That's neat, although the left channel of my wireless earbuds drop out like 2% of the time! What I want is a shoulder implanted pacemaker that's significantly smaller, with a quarter of the primary battery capacity, and an inductively charged supercap that can store enough charge to run at least week between charges.
lake-view 4y ago
> Maybe my cardiologist is just trying to make me feel good, but he says my leads will likely last 30-50 years. Intuitively that seems unlikely, but we'll see. It's got to be one of the most engineered cables in existence. One of my favorite learnings in school was about the "Endurance limit". Some materials, like aluminum, will eventually fail under cyclic loading even at tiny, tiny loads. This was a big problem when they built the first passenger jets. Other materials, like steel, have a threshold at which they can be cycled indefinitely without issue. For something like a pacemaker, I like to imagine they dialed the materials and forces to be within such a threshold so you can keep on ticking!
- tengwar2 4y ago
  Re passenger jets - I imagine you are thinking of the Comet 1? That was a more complex failure than is generally known. In brief, they did know about fatigue life at the time, and had ways of retiring aircraft before it was an issue (safe-life design, apparently introduced in the 19C for steam engines despite their being iron and steel). Ok, now you will be thinking "square windows, stress concentrators". Almost all pressurised aircraft use windows with angled corners in the cockpit. There isn't an intrinsic bar to square windows, and in fact the original design would probably have been ok. That used glued installation, avoiding stress concentrators. However a production engineer changed the design to use riveted installation, which caused the well-known problem with hull failure. Still, that would have been discovered if DH had not managed to resist government pressure to do fatigue testing on the pressure hull (because they were racing Boeing to be first to market, and fatigue testing takes time). They actually had the apparatus for repeatedly pressurising the hull in a bath, but only used it for testing static pressure.

samstave 4y ago

sgtnoodle 4y ago
Lol. I've certainly already made the joke that embedded systems are dear to my heart. I'd consider working a few years at a place like Medtronic just to see what I can contribute, but on the other hand I hear there's roughly a 2:1 ratio between requirements and lines of code. Going through airport security is fun just because the TSA agents overreact as if the metal detector is going to kill me.
- samstave 4y ago
  DYSTOPIAN OUTCOME: /u/sgtnoodle has accepted a great job with MedTronic, little does he know, that as a QA process embedded engineer, his duties require him to monitor various labs - including the PENTEST/AGGRESSIVE attack lab... but the anechoic chamber contract was low bid - and has leaks... As he walks by the lab, checking his tablet for his various checklists... there is a leak. A deadly leak... As he rounds Corridor-4A toward his desk, the leak hits him. As a Class-I Mk2 Embedded engineer, he was susceptible to the RF attacks... We only found him after the alarm sounded that he badged through Door X1A, but never made it to Door TR3B where his lab was... Cardiac failure due to failed electro-stim documented as cause of termination of employment.
LastTrain 4y ago
You are getting downvoted for the conspiracy theory aspect of your post and for throwing shade on a guy with the pacemaker. If you care about being liked, say likeable things.
- samstave 4y ago
noisy_boy 4y ago
Yeah this knee jerk downvoting sucks. Have an upvote.

guhidalg 4y ago

My heart sank when you mentioned a BLE-enabled pacemaker. Has technology gone too far? /s

melq 4y ago
It sounds like the bluetooth functionality is only there for telemetry.
- samstave 4y ago
  An interesting thought would be to have a nano-lead down the arterials to the wrist, where an external telemetry relay-watch could read the signals, and have the BLE device top dermal. (apple watch) eliminating RF/BLE bullshit from talking to the pacemaker.
  - sgtnoodle 4y ago
    Being pragmatic, that sounds way worse than just having a little ceramic 2.4ghz antenna and some extra silicon potted into the device!
    - samstave 4y ago
      https://www.dailymail.co.uk/news/article-2379009/Barnaby-Jack-dead-days-demonstrate-kill-fitted-pacemaker.html https://www.dailymail.co.uk/news/article-2379009/Barnaby-Jac... - Oops - I didnt realize you were same poster from other comment
      - sgtnoodle 4y ago
        I don't think my particular pacemaker has the necessary circuitry to generate more than 5V, in pulses less than a few milliseconds. The voltage doesn't really matter much to the muscle. If you got in you could probably put the leads into single-ended mode (so that there's more current path to cause mayhem) and pace my atrium and ventricles at 210bpm, and effectively give me a seizure. I can't imagine it would kill me before an EMS arrived with a magnet? Perhaps a more nuanced attack would be to somehow use all the configuration parameters to intentionally bias the pulses so that there's net charge going into the muscle. Over a long time that would cause tissue damage. If someone wanted to kill me overtly, a gun would be less work. A pacemaker malfunction that bad would be thoroughly investigated, and would be fixed in new devices within a year or two.

alphaoverlord 4y ago

If you have complete AV block, a leadless pacemaker is less good than one with multiple leads, since it allows pacing multiple chambers and maintaining synchrony between A and V.

animatedb 4y ago
There are now leadless devices that communicate with each other using RF.
- sgtnoodle 4y ago
  That's neat, although the left channel of my wireless earbuds drop out like 2% of the time! What I want is a shoulder implanted pacemaker that's significantly smaller, with a quarter of the primary battery capacity, and an inductively charged supercap that can store enough charge to run at least week between charges.

lake-view 4y ago

> Maybe my cardiologist is just trying to make me feel good, but he says my leads will likely last 30-50 years. Intuitively that seems unlikely, but we'll see. It's got to be one of the most engineered cables in existence. One of my favorite learnings in school was about the "Endurance limit". Some materials, like aluminum, will eventually fail under cyclic loading even at tiny, tiny loads. This was a big problem when they built the first passenger jets. Other materials, like steel, have a threshold at which they can be cycled indefinitely without issue. For something like a pacemaker, I like to imagine they dialed the materials and forces to be within such a threshold so you can keep on ticking!

tengwar2 4y ago
Re passenger jets - I imagine you are thinking of the Comet 1? That was a more complex failure than is generally known. In brief, they did know about fatigue life at the time, and had ways of retiring aircraft before it was an issue (safe-life design, apparently introduced in the 19C for steam engines despite their being iron and steel). Ok, now you will be thinking "square windows, stress concentrators". Almost all pressurised aircraft use windows with angled corners in the cockpit. There isn't an intrinsic bar to square windows, and in fact the original design would probably have been ok. That used glued installation, avoiding stress concentrators. However a production engineer changed the design to use riveted installation, which caused the well-known problem with hull failure. Still, that would have been discovered if DH had not managed to resist government pressure to do fatigue testing on the pressure hull (because they were racing Boeing to be first to market, and fatigue testing takes time). They actually had the apparatus for repeatedly pressurising the hull in a bath, but only used it for testing static pressure.