Until 25 years ago, the classic pacemakers, which were used for the therapy of a too slow heart rhythm, were the only representatives of the “cardiac devices”. In the meantime, the spectrum has been expanded, especially by intracardiac defibrillators (ICDs), which enable the therapy of rapid cardiac arrhythmias (ventricular tachycardia, ventricular fibrillation), as they occur mainly in patients with severe cardiac insufficiency. Certain patients with heart failure have “electrical dyssynchrony”, which can be corrected by a biventricular pacemaker for resynchronization of the heart chambers (CRT). In cooperation with the heart failure department, we decide – with the involvement of the external cardiologists and general practitioners – which patients are suitable for which device implantation.
Our team has extensive experience in the implantation of cardiac devices and their optimization and follow-up. All patients with CRT, as well as certain high-risk patients with ICD and pacemakers, are monitored by us via “remote monitoring”. If there is a severe arrhythmia, malfunction, or “water overload” of the body, a central server sends a message and the necessary therapeutic steps are initiated. For ICD patients, remote monitoring can reduce overall mortality.
The subcutaneous ICD, which does not require electrodes in the veins due to its completely extrathoracic location, is a good alternative for certain patients, especially young ones.
For some time now, the so-called miniature leadless pacemaker has been available, a small pacemaker without an electrode, which is anchored in the right ventricle. This procedure is particularly gentle and can be considered especially for older patients and patients with very slow atrial fibrillation. Together with the attending cardiologists, we evaluate referred patients with regard to cardiac devices. In addition, we have established a program for electrode removal, which is performed under the best possible conditions in the hybrid cardiac surgery operating room together with cardiac surgery. In patients with recurrent syncope of unclear origin, the use of implantable loop recorders (over several years) can lead to a diagnosis (e.g. asystole or AV block).