Pacemaker Implantation

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A pacemaker insertion is the implantation of a small electronic device that is usually placed in the chest (just below the collarbone) to help regulate slow electrical problems with the heart. 2020-03-12 Pacemaker Implantation
All you need to now about Pacemaker Implantation
Pacemaker implantation
Pacemaker implantation

German Medical Group will help find you the best heart clinic in Germany. It is known that constant cardiac rhythm disturbances are of great danger to our lives. If a patient has serious problems with contractile cardiac muscle function manifesting in stable arrhythmia, pronounced bradycardia or ciliary arrhythmia, the only way to escape the danger is pacemaker (electric cardiostimulator) implantation.

Thanks to the progress in modern medicine in Germany things are different now. A pacemaker is fixed inside the body, it has smaller size and weight compared to its prototypes, and it operates on lithium batteries which last from 6 to 14 years and are remotely programmed. A new generation of pacemakers helps to effectively resynchronize cardiac beats due to electrodes which are connected both to right and left ventricles of heart. The impulse first stimulates the left and then the right ventricle, as it normally happens in a healthy heart. Nowadays many patients in need of electric cardiostimulation come to Germany, worldwide leader in cardiosurgery, for pacemaker implantation.

Local anesthesia is used while pacemaker is being inserted. The pacemaker surgery in Germany usually takes about 20-30 minutes, although previously it took up to a few hours. The device is inserted either under the skin or pectoral muscle so that the patient wouldn’t even feel it. Cardiological clinics of Germany use only high-technology pacemakers which can be reprogrammed, if necessary, without surgical procedure. Functions of the pacemaker are checked externally, through the skin.

Causes of insertion of a pacemaker

Normally, in the heart, more precisely in a small node on the right atrium (sinus node), rhythmic electrical excitations are formed. These are passed through the heart wall and lead to a contraction of the heart muscle, the blood is thus pumped through the circulation. Problems in this arousal formation and conduction lead to arrhythmias, in particular to slow down the heart rhythm (bradycardia). A so-called replacement rhythm occurs, which is not controlled by the sinus node as usual, but starts from other structures of the heart wall and is usually much slower.

Various circumstances can lead to such cardiac arrhythmias. Often there is damage to the heart, for example, previous heart attacks, heart valve changes with heavy stress on the heart, coronary heart constrictions (coronary heart disease, CHD) or myocarditis (myocarditis). However, the cardiac arrhythmia can also be triggered outside the heart, e.g. by certain substances (for example, medicines, drugs), by hypothyroidism or by psychic reactions.


Different forms of cardiac arrhythmias are distinguished. They are roughly subdivided into too fast a heartbeat (tachycardia) and too slow a heartbeat (bradycardia). The adult normal rate is around 60 to 100 beats per minute.

Many cardiac arrhythmias have no symptoms and do no harm. However, different species can become life-threatening. Several arrhythmias can occur simultaneously.

If the heart is beating too slowly (bradycardia), the blood supply in the body drops. This is especially noticeable in the brain, it comes to, among other things, fatigue and dizziness. The patient may become unconscious. The slowed or halting heart activity is often directly noticed as heart stumbling, dropouts or the like.

There are several other forms of cardiac arrhythmias, which should not be discussed here, as treatment with the conventional pacemaker is only possible if the heart rhythm is too slow. For too fast cardiac actions, another type of pacemaker, the so-called cardioverter defibrillator, is recommended.


Occasionally, the symptoms, the patient's accounts (anamnesis) and the physical examination already suggest a cardiac arrhythmia. An ECG is performed, which shows typical changes in each case. A long-term ECG (24-hour ECG) is also recommended to detect disturbances that only occur intermittently. Sometimes further investigation methods are used, e.g. experimental medication or a so-called electro-physiological examination (EPU) using a cardiac catheter.

Since other types of cardiac arrhythmias may have similar symptoms, they must be distinguished from bradycardia (slowing of the rhythm).

Types of pacemakers

Cardiologists, experts in cardiac issues and problems, distinguish several forms of cardiac pacemakers. In addition to the classic model, there is also a transcutaneous pacemaker. Furthermore, there is an insertable defibrillator in a greatly reduced form. In addition to the above forms, there are also permanent units that work in one, two or three chamber units. In total, there are five types of pacemakers that differ based on the location of the stimulation.

Extracardiac stimulation

Extra means functioning outside the body In the early stages of pacemaker treatment, electrodes were sutured directly to the heart. Today, the lead wires are routed right through the skin at the bottom of the breastbone. However, this practice is only used after interventions on the heart.

Intracardiac stimulation

An electrode is inserted into the right half of the heart and inserted through a vein. The operation takes place at the open heart. The electrode is thereby fixed to the heart with an external stimulation. Due to the high risk of infection, this therapy is not recommended and is only suitable for temporary treatment.

Transcutaneous Stimulation

This is an external pacemaker that places large stick-on electrodes on the skin, which then deliver small surges that stimulate the heart. Since there is no direct contact between the heart and the surge, higher currents are necessary. The procedure is therefore more suitable for emergency situations, as the increased current strength stimulates the skeletal muscle unintentionally.

Esophageal stimulation

An electrode is pushed through the esophagus and placed at the level of the heart. The procedure is very painful and is rarely used, which is why it is not very common.

Intracardiac stimulation

The most commonly used procedure in practice is intracardiac stimulation by an inserted implant. The HSM is implanted above the left (or right) breast under the skin or under the large pectoral muscle.

Amongst these different types of cardiac pacemakers, there are still different types which, depending on the structure, have a different function.

The implanted pacemaker can be set wirelessly by using an interrogator or by setting it directly on the external HSM. The pacemaker not only serves the electronic transmission of pulses, it also measures the heart function and creates an ECG which can be evaluated. If no heartbeat is detected within a certain time, stimulation will be by the electrical impulses.

The devices of the single-chamber pacemakers of the VVI series are among the most frequently used. These ensure that there can be no overactivity of the heart. It switches on automatically when needed and acts when the heart ventricle is not active. It then automatically shuts off again when the heart chambers are working properly again. The dual-chamber pacemakers serve as an atrial pacemaker and should prevent ventricular fibrillation.


The functional principle of the pacemaker includes that when measuring a too slow heartbeat or misfires small electrical shocks are delivered to the heart. This will then stimulate one heartbeat at a time.

A pacemaker can be permanently applied depending on the findings or illness and is put into the body, or a temporary pacemaker is used in which only the electrodes are inside the body, but the power supply unit with the battery is outside.

In the procedure of implanting a permanent pacing device, a pocket of tissue is made beneath a collarbone in local anesthesia. In this the pacemaker is inserted. When this is done, an electrode is inserted over the vein below the clavicle (subclavian vein) and brought inside the heart. The electrode is positioned for a single-chamber pacemaker at the lower end of the right ventricle. If a two-chamber pacemaker is installed, another electrode is fixed in the right atrium. The advancement of the electrodes is similar to a cardiac catheter examination and is done by fluoroscopy with an X-ray machine. The electrodes are then connected to the pacemaker.

If a temporary (temporary) pacemaker is applied, only the electrodes are inserted over the vein as in permanent implantation. The connections to the pacer device, which is externally attached, protrude from the lower neck area.

After years of operation, a replacement of the pacemaker is required. If poor battery performance is detected, local anesthesia is given and the bag is reopened to the patient's skin by cutting. After removing the old and inserting a new device, this is connected to the existing electrodes.

After successful insertion of the pacemaker system is checked by control measurements, if the device works.

Occasionally, it may be necessary to add more electrodes or probes.

In some circumstances, it may be that the electrodes can not be inserted through the vein. In this case, it may be necessary to attach the electrodes to the outside of the heart wall via a more complex operation.

Even complications may make it necessary to take other measures than planned.


There is a risk of bleeding and rebleeding. Nearby structures can be damaged, e.g. Nerves with possible signs of paralysis, numbness or other failures. It can not be ruled out that the heart muscle is damaged. The lungs can also be affected under certain circumstances, with defects in the pleura it can come to air accumulation, which hinder the respiration (pneumothorax).

At this point, as well as around the heart, it can also come to effusions, which can severely affect the function. Inflammation, wound healing disorders and scarring can also be triggered.

Also allergic reactions are possible. Blood clots may form that result in deficient blood circulation in various parts of the body, e.g. also the lungs (pulmonary embolism), can lead. Problems with pacemaker components, e.g. Failure, displacement, or damage can not be excluded.

Note: This section can only give a brief outline of the most common risks, side effects, and complications, and is not exhaustive. The conversation with the doctor can not be replaced.


Pacemaker operations are performed very often and many people have become accustomed to living with the device. Life-threatening conditions are usually reliably detected by the pacemaker and can be reversed by targeted stimulation.

Since cardiac arrhythmias often occur as a result of other illnesses, the prognosis also depends on it and on the respective optimal treatment.

What are the risks of the pacemaker?

Although pacemaker surgery is a relatively safe procedure, complications can not always be avoided. Nearly every 30th pacemaker implantation leads to a misplacement of the probes. Consequences may be functional limitations of the device, vascular injuries or cardiac arrhythmia. The latter are usually recognized and treated in the hospital.

If the patient suddenly hiccups after a pacemaker surgery, this indicates an unwanted electrical excitation of the diaphragm. Normally, you then have to perform a pacemaker operation again, in which the wires are repositioned differently.

Often a bruise (hematoma) forms in the area of ​​the wound below the collarbone. As a rule, it does not need to be treated as it gradually degrades itself. However, the doctor should rule out major bleeding.

If, after a pacemaker operation, the wound swells and reddens, there may be a bacterial infection behind it. In that case, it is important to have regular wound control and doctor treatment, especially if the patient experiences fever or feels weak and beaten. Sometimes antibiotics are needed for treatment or the wound needs to be reopened.

This must be observed after implantation!

About ten days after the implantation of a pacemaker, the skin has recovered to a normal wound healing at the surgical site under the clavicle so that the threads can be pulled. To avoid delayed wound healing or even germ introduction, it is recommended that the skin be gently wiped clean with a washcloth around the wound (the dressing should not be wet). Once the wound has healed and the threads are pulled, you can again wash normally or shower and bathe.

Arm with new pacemaker not above chest height

In order for the healing process to be optimal and no pacing on the pacemaker probes, the arm on which the pacemaker was inserted should not be raised above chest height for about two weeks after implantation.

In order to ensure optimal functioning of the pacemaker, then later in the course of regular checks are necessary, either in-house cardiologist or in the pacemaker outpatient clinic of the hospital. In the process, the state of charge of the pacemaker battery is checked, the functionality of the pacemaker probes is measured and various data for the pacemaker function are read out, eg. For example, how often has the pacemaker in the past supported the heart rhythm with impulses, or has there been any particular occurrences of cardiac rhythm? The first check-up after discharge from the hospital or the institution where the pacemaker implantation was performed will take one to three months. Subsequently, the follow-up intervals should be six to twelve months.

When the battery of the pacemaker is exhausted

Longer intervals between two follow-up examinations are possible when a so-called telemedicine monitoring takes place, in which the most important pacemaker data is automatically read out automatically by radio from a small additional device outside the body depending on the manufacturer and from there encrypted via the mobile or telephone network to the caregiver Heart center to be transmitted. Shorter intervals between follow-up examinations, on the other hand, are required if the battery gradually becomes depleted and, for this reason, closer monitoring is advisable. In this way, a change of the pacemaker assembly as long as possible delay, without the risk of pacemaker failure due to an empty battery.

Attention with reddened skin over the pacemaker

Complications are very rare after implantation of a pacemaker. Nevertheless, a pacemaker carrier should know the main potential complications and their early signs. In rare cases, pacemaker infections may occur. Usually the skin is stretched over the pacemaker, strikingly warm and reddened. In such a situation, you must see a doctor immediately. Most often, the entire pacemaker system must be removed immediately to prevent the spread of the inflammation on the body or the heart. At a later date, a new pacemaker can be implanted. Note: As a so-called "general signs of infection" in such a situation also fever and chills are possible (similar to a flu), which should understand people with a pacemaker as another alarm signal or as an invitation to go immediately for medical treatment.

You should also seek medical advice if swelling occurs in the area of ​​the pacemaker assembly, even if no simultaneous redness or other signs of infection are detected. It is possible that a bruise has formed which rarely requires surgery but should be controlled.

Cell phones as a source of interference for pacemakers?

With newer pacemakers, experts today usually no longer expect any significant interference from cell phones. This applies in particular if bipolar pacemaker electrodes have been implanted, which provide a clear plus in terms of safety against external interference. For safety, however, it is still recommended to keep a minimum distance of 15 to 20 cm between the switched on cell phone and pacemaker. In practice, the recommendation can usually be implemented simply by holding the cell phone to the ear opposite the implanted pacemaker unit to make the phone call. In addition, the activated cell phone should not be carried in the shirt or jacket pocket, which is near the pacemaker.

Hair dryer, electric toothbrush and razor a risk?

The Heart Foundation consultation always asks whether common bathroom devices can interfere with the pacemaker. Z are harmless. B. electric toothbrushes, razors, curling irons or the hair dryer.

Kitchen and household appliances: keep a distance of 15 to 30 cm

There should be a minimum distance of 15 to 30 cm from household appliances to the pacemaker (e.g. stove, toaster, washing machine, dishwasher, dryer, electric can opener). For induction cookers, it is also important to use the operating instructions to make sure that the use of the respective induction cooker is generally permitted for pacemaker wearers or whether the manufacturer provides additional information for pacemaker wearers.

At home and at work: be careful with electrical tools!

The safety distance when handling electrical tools should not be underestimated, which includes both professional activities and DIY work. In drilling machines, for. B. maintain a minimum distance of 30 cm to the pacemaker unit. The same applies to electric fretsaw or chainsaws as well as cordless screwdrivers and other cordless tools. Pay particular attention to the minimum distance of 30 cm when using electric lawnmowers and hedge trimmers, since their motors are often not adequately shielded.

A special procedure is required if you have to be a professional pacemaker in certain industrial plants, e.g. B. in the vicinity of transformers, high-voltage operating systems, induction furnaces, electrolysis systems, certain welding devices or systems with permanent magnets. In these special cases, you should contact your cardiologist, who can arrange an individual visit to the workplace in order to assess a possible hazard as accurately as possible.

Heart problems after pacemaker implantation again?

If your heart problems initially improve after pacemaker implantation, but then return later, you should also consult your GP or pacemaker care professional. A pacemaker probe may have slipped to transfer the electrical impulses from the pacemaker pulse generator to the heart, which can be quickly resolved in a control exam. In order to remedy such a problem, it is often sufficient to fix the probes with a small intervention, without having to replace the complete pacemaker.

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Latest News in Pacemaker Implantation

New pacemaker can resolve itself


The pacemaker is one of the most impressive and significant inventions of modern medicine. Hundreds of thousands of the tiny devices are implanted every year to help people with arrhythmias. But sometimes an operation is only necessary temporarily, but surgery would have to be carried out again to remove it. To avoid this unnecessary risk, a pacemaker has now been developed which can be completely broken down by the body.

After a heart attack, heart surgery or medication overdose, the heart often needs a pacemaker to function properly and to ensure that it does not fail. However, after a while, the heart often stabilizes again and the pacemaker has to be removed again through another operation on the heart.

There are already temporary pacemakers that do not require a new operation. But with these, the pacemaker electrodes are sewn directly onto the heart muscle and the necessary wires are fed out of the patient's chest so that they can be connected to an external pacemaker box. This procedure is risky because the slightest slippage of the wires can loosen important connections. In addition, the area where the wires emerge from the chest can easily become infected. In addition, the entire procedure is extremely uncomfortable for the patient, who has to be constantly undergoing treatment to ensure that the sensitive equipment is working properly.

A team from Northwestern University has now designed a temporary pacemaker, which is simply broken down by the body at the end of its use. The device consists of plastic-like biopolymers, which are already used in other areas of medicine. Even the silicon-containing parts of the new device, which are responsible for the electronic functions, break down into completely harmless substances. By slightly varying the thickness and material composition of the various parts, it is possible to determine exactly how long the pacemaker should take to decompose.

The pacemaker that is implanted is extremely thin and weighs less than half a gram. It receives energy wirelessly through resonance-inductive coupling, a technology that is also used in some cell phones. There is an energy transmitter on the chest that sends the energy wirelessly to the pacemaker. As soon as it is no longer needed, the transmitter can be removed without any problems and the actual device on the heart breaks down completely. In contrast to the previous options for temporary pacemakers, the new technology is far less complicated, safer and more comfortable for the patient.

Some prototypes of the new invention have already been tried out on mice, rats and dogs and worked perfectly. Since the new technology is also more cost-effective than previous temporary pacemakers, the scientists involved hope that the device will soon be approved for humans, which could quickly prevail over traditional pacemakers. The underlying biodegradable technology could also be useful for other implants such as defibrillators or insulin pumps. In the study, which was published in the journal Nature, the authors also write that the technology heralds a new generation of temporary pacemakers.

Pacemaker stimulates natural heartbeat


Decreasing cardiac output, cardiac insufficiency or cardiac insufficiency is a frequently observed long-term consequence in pacemaker patients. Cardiologists at the Department of Internal Medicine II - Cardiology, Angiology and Intensive Care Medicine at the St. Marien Hospital Siegen have now implanted an innovative pacemaker for the first time in patients.

The innovative pacemaker stimulates the so-called His-bundle, part of the internal stimulation conduction system. Thereafter, the signal spreads over many small fibers in the heart muscle sections and thus triggers physiological, i. natural heartbeats. In this stimulation, a pacemaker probe is placed in the vicinity of the bundle of His above the sails in the area of the forecourt septum to allow natural transmission of the electrical impulse of the pacemaker as possible to the chambers. The risk of developing heart failure is thus significantly reduced. The clinic of chief physician Prof. dr. med. Michael Buerke is one of the first heart centers nationwide to have established this new form of therapy, the His bundle pacemaker, in regular patient care. "The procedure is technically more complicated than the simple probe placement in the right ventricle and the operating time is longer," explains senior physician Dr. med. med. Christoph H. Blanke, who works together with senior physician Dr. med. Johann Mermi implanted the first pacemaker. The procedure is controlled by many ECG leads, and it may be useful to use an electrophysiology catheter from the right-hand panel.

Heart failure leads to premature fatigue, decreased performance and fatigue in many sufferers. But respiratory distress or water retention in the lungs or legs occur. Depending on the severity, the quality of life is noticeably affected. "With the help of the innovative His-bundle pacemaker, the pumping power of a previously damaged heart does not diminish after some time, unlike with normal pacemakers," reports Dr. med. Mermi. "The risk of patients having to be hospitalized again due to pacemaker-associated heart failure is therefore extremely low," continues the electrophysiologist. In addition, there is a trend towards a lower mortality in the long-term trend.

"The His bundle probe implantation means a global change in pacemaker therapy," says chief physician Prof. Dr. med. Michael Buerke. Because the Kammersonde traditionally in quite a different place and indeed attached near the top of the right ventricle. If they give off an electrical impulse there, it spreads "unnaturally" from the right into the left ventricle. This electrical and mechanical asynchrony of the heart chambers can lead to long-term heart failure.

The special position of the His bundle probe is also a particular challenge for the surgeons. Because the bundle of His, named after the German internist and cardiologist Wilhelm His (1863-1934), is only a few millimeters small structure in the heart septum between the atria and chambers. "Accurately localizing it requires complex technical prerequisites," says Dr. Johann Mermi. "At the Heart and Vascular Center in South Westphalia, we have a modern electrophysiology lab and OR equipped with the His bundle emitting an unmistakable electrical signal We know exactly when the catheter has reached it and can place the probe exactly."

"Pacemakers have been used in patient care for decades," explains Prof. Michael Buerke. But apart from advances in more personalized programming, longer battery life or the introduction of the pacemaker capsule implanted directly into the right ventricle, the His bundle pacemaker has for decades been the first fundamental advance that promises to reverse the drawbacks of conventional pacemakers. The new pacemaker will therefore be standard in patients who are medically indicated for use, concludes Prof. Buerke.

Pacemaker without batteries


This invention could greatly facilitate the lives of millions of people with a pacemaker. So far, the implanted device, which stimulates the heart to beat regularly by electric impulse, runs with batteries. And they have to be exchanged every few years. This requires a small surgical procedure.

But that might not be necessary in the future, if the invention of Chinese researchers prevails: The scientists have developed a pacemaker, which requires no batteries at all.

The energy needed to operate the pacemaker is generated from the movement of the heart, reports, referring to the development of researchers around Han Ouyang from the Beijing Institute of Nanoenergy and Nanosystems, which is now described in the journal Nature.

Development has not progressed so far as to enable operation in the human body. For this, the system must be even smaller and more efficient, so the Chinese scientists.

Initial tests with pigs make them confident that this could succeed. Because, according to the study, enough energy could be generated to eliminate arrhythmias in the animals.

The researchers could have made a first important step: "The performance of the device is impressive, because it is four times as high as in previous approaches of this kind," quoted the researchers Han Ouyang.

"The symbiotic pacemaker absorbs energy from the body to do its job. At the same time, the body gets electrical stimulation from the pacemaker to regulate the heart's activity, "says Ouyang, pointing out that the device developed by his research team is well tolerated and durable.

Pacemakers are implanted in people whose heart rhythm is disturbed.

Patient Comments

Stephan O.
One can only judge this doctor well. He is friendly, empathetic and competent. The patient is obviously important to him. Because of my high blood pressure, I was treated professionally by him myself. When I casually reported to him about my wife's constant fainting spells, he immediately gave me a long-term ECG device for her, even though she wasn't his patient at the time. That might have saved her life. It soon turned out that my wife had a Q3 block. Dr. Ischinger read the device immediately, organized an ambulance and informed the clinic doctors. On the same day, my wife was fitted with a pacemaker in the clinic. We are immensely grateful to Dr. Ischinger. This doctor is great.
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Samuel B.
I have been in treatment with Dr. Lange since January and during this time I have come to appreciate his absolute professional competence. His expertise is very convincing and, for example, completely took away my fear of having a pacemaker implanted. This also applies to my regular pacemaker checks, where he takes enough time and always answers my questions to my complete satisfaction. I can only thank Dr. Lang for his help and kind treatment of a patient and will continue to be his patient.
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Julia Shipton
After several unsuccessful attempts with other cardiologists, Dr. Hagl managed to program my pacemaker in such a way that my shortness of breath during exertion, e.g. climbing stairs, is finally eliminated. So I can only recommend it!
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