Herz & Rhythmus Zentrum

PACEMAKER
BRIDGING THE CONDUCTION

As microelectronic systems, pacemakers take over the function of the body's own pacemaker. This is used in situations, where bradycardia (too slow pulse) occurs. The pacemaker then takes over the stimulation and ensures an adequate pulse. Advances in pacemaker technology enable modern systems to control up to three chambers, to ensure the physiological flow of cardiac electrical activity.

BRADYCARDIA, SLOW ARRHYTHMIAS, ATRIAL FIBRILLATION AND MORE

Atrial fibrillation is the most common cardiac rhythm disorder. As such, atrial fibrillation can either directly lead to a slow pulse (bradycardia) or the medication required to treat atrial fibrillation can cause a small pulse. However, bradycardia can also occur without atrial fibrillation, e.g. an AV blockage. This situation occurs when the electrical conduction system within the heart is sick. This disease leads to symptoms such as dizziness, shortness of breath and syncope. The treatment is a dual-chamber pacemaker. Two-chamber means that the atrium and the ventricle are each provided with an electrode (cables) connected to the pacemaker. Finally, resynchronization may be necessary in certain situations, in which case a 3-chamber pacemaker, also called a bi-ventricular system, is used.  

PACEMAKER IMPLANTATION

With atrial fibrillation and other cardiac arrhythmias, pacemakers are used to bridge the diseased conduction system of the heart. The pacemaker consists of a housing and one or two electrodes (cables) that generate the connection between the unit (battery) and the heart. The electrodes connect the chambers of the heart through the venous system to the pacemaker, which lies under the skin just by the clavicula. With the electrodes, the pacemaker adapts its performance to the heart and ensures a sufficient pulse rate, in case it stops.

Single-chamber pacemakers are used for slow atrial fibrillation, and dual-chamber pacemakers are mainly used for patients with a sick sinus node or AV block. There are also three-chamber pacemakers (bi-ventricular systems) used for patients with cardiac muscle weakness. 

ELECTRODE (Lead) EXTRACTIONS AND PACEMAKER CHANGE

The Heart & Rhythm Centre specializes in the removal of old pacemaker electrodes when they are no longer necessary. These can potentially be very difficult interventions, that are carried out in the hybrid operating room, where a heart-lung machine is always on standby. These procedures are always performed in a HeartTeam setting with an experienced cardiac surgeon present. 

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