Pacemakers are electronic systems that make the prevention of various cardiac arrhythmias possible that lead to an excessively slow pulse. Progress in microelectronics has led to today’s modern systems being able to control up to three chambers of the heart, thus ensuring that the electrical activity of the heart is as physiological as possible. Life-threatening cardiac arrhythmias are eliminated by means of so-called internal defibrillators (ICD), which also offer a pacemaker function.
The pacemaker or defibrillator is implanted under local anaesthetic (local anasthesia) under the skin below the collarbone. The necessary electrodes are inserted through a vein into the respective heart chambers, where they are actively fixed by means of a small spiral screw or passively by a so-called anchor. The procedure usually takes half an hour to an hour. The patient is monitored for one night and the pacemaker or defibrillator system is checked again before leaving.
Every pacemaker or defibrillator system must be checked at regular intervals (every 6 to 12 months) in order to detect changes in the battery voltage or on the pacemaker probes in good time or to be able to adapt the programming to the requirements of the patient. The outpatient examination takes about 30 to 45 minutes. The device is painlessly scanned and programmed from the outside using a magnetic head or WIFI system.
Naturally, the heart chambers are electrically excited shortly after each other. This causes heart muscle activity. In the case of heart muscle weakness, caused for example by a heart attack, this chronological sequence can be delayed. State-of-the-art pacemaker systems that supply up to three heart chambers can, under certain conditions, compensate for this delay and thus help to improve heart performance. The implantation is more complicated than with conventional systems and can take several hours.
Cardiac arrhythmias, which are perceived by the patient and can even lead to unconsciousness, but which cannot be documented by conventional methods such as ECG or long-term ECG, can be detected by a small device implanted under the skin in the chest or, more recently, on the forearm under local anaesthetic. A hospital stay is often not necessary. The device is also interrogated from outside and removed again after successful recording.
The implantation of a pacemaker or internal defibrillator is generally associated with risks. A correct indication and a detailed examination before the procedure are therefore essential to avoid taking unnecessary risks. Due to concomitant diseases, the risks of intervention can vary in their probability. A personal consultation is essential to clarify the individual risk.