Transvenous Pacemakers
Pacemakers have been used successfully in the treatment of slow heart rhythm disturbances for more than 50 years.
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What is a pacemaker?
Pacemakers have been used successfully in the treatment of slow heart rhythm disturbances for more than 50 years. Classical pacemaker systems consist of a device approximately the size of a matchbox, which contains a lithium battery and the electronic components, and leads, which connect the device to the right upper chamber (atrium) and/or the right lower chamber (ventricle). Pacemakers are used to monitor the heart rhythm and stimulate the heart if the heart rhythm is too slow (bradycardia). The patients do not feel this because it requires only a very weak current. The number of leads depends on the underlying heart rhythm disturbance.
Diseases treated with classical pacemaker systems include:
- Diseases of the sinus node (sick sinus syndrome). With these disorders, the function of the natural pulse generator of the heart, the sinus node, is disturbed.
- Disorders of the atrioventricular conduction (AV block). In these cases, the conduction of the electrical excitation between atrium and ventricle is disturbed.
Dizziness, shortness of breath, poor performance, and fainting spells are typical symptoms when the heartbeat is too slow.
How are pacemaker systems implanted?
Classical transvenous pacemakers are inserted below the clavicle into a tissue pocket under the skin or between the chest muscles under local anesthesia and the additional administration of sedatives. Under radioscopic monitoring, one pacemaker lead (single-chamber pacemaker) or two pacemaker leads (dual-chamber pacemaker) are advanced to the right heart through veins leading to the heart, where they are anchored at the cardiac membrane with a screw mechanism.
The first postoperative outpatient follow-up takes place at our pacemaker outpatient department after usually 4 to 6 weeks. Further follow-ups of the pacemaker systems are performed at fixed intervals (every 6 to 12 months) at our pacemaker outpatient department or at a colleague's medical practice.
Implantation of Leadless Pacemakers
What is a leadless pacemaker?
In contrast to conventional pacemakers, these pacemakers are implanted directly into the right ventricle as completely closed system and therefore do not need any leads. With a comparable battery lifetime, this innovative pacemaker system is much smaller than conventional pacemaker systems, which are about 10 times as large. However, the leadless pacemaker is only suitable for patients who only require pacing of the right ventricle. Leadless pacemakers with the option to pace in the atrium and the ventricle (comparable to a conventional dual-chamber pacemaker) are still being developed.
How are leadless pacemaker systems implanted?
The leadless pacemaker is anchored in the right ventricle under local anesthesia and additional administration of sedatives. Via access through a femoral vein, the complete system is pushed into the right heart over a catheter and implanted there. The follow-up of the pacemaker system take place at fixed intervals (every 6 to 12 months) at our pacemaker outpatient department or at a cardiologist's practice.