Implantable cardiac devices

Cardiac pacing uses implantable devices for a number of different reasons. Devices used include: event recorders, which help diagnose cardiac arrhythmias; pacemakers, which help in the monitoring and treatment of bradyarrhythmias (slow heart rhythms); and defibrillators, which help in the monitoring and treatment of tachyarrhythmias (fast heart rhythms).

What is meant by implantable cardiac pacing devices?

An event recorder (also known as a loop recorder) is a small monitoring device - the size of a USB stick or smaller - that is implanted under the skin and used to diagnose arrhythmias by recording the cardiac events associated with them.

A pacemaker is an approximately matchbox-sized device that is used to monitor and treat bradyarrhythmias (slow heart rhythms).

A defibrillator is used to monitor and treat tachyarrhythmias (fast heart rhythms), and also provides protection against sudden cardiac death.

Development of implantable cardiac pacing devices

On 8 October 1958, Arne Larsson became the first patient to be fitted with a fully-implantable pacemaker. The procedure was carried out by Rune Elmqvist, an engineer working at Siemens-Elema, and Åke Senning, a Swedish cardiologist.

On 4 February 1980, the first successful implantation of an automatic defibrillator was carried out at the Johns Hopkins Hospital in Baltimore. The procedure was performed by the American cardiologist Michel Mirowski. Following this event, the automatic implantable defibrillator - and later the automatic implantable cardioverter defibrillator (ICD) - became one of the most successful therapeutic devices used within the field of cardiology.

What conditions are treated using implantable cardiac pacing devices?

  • Sinus node disease
  • Disorders affecting the atrioventricular (AV) node (e.g. AV block)
  • Slow atrial fibrillation
  • Ventricular tachycardia
  • Primary ventricular fibrillation
  • Frequent unexplained syncope (fainting) with complete loss of muscle tone
  • Heart failure with decreased ventricular function (LVEF ≤ 35%)

How can implantable pacing devices help?

The implantation of an event recorder beneath the patient's skin is advisable if the patient experiences recurrent syncope (fainting spells) with complete loss of muscle tone, which remains unexplained despite a thorough investigation using a wide range of diagnostic techniques. The device can be used to record data on relevant cardiac events for a duration of approximately 3 years. What is even more important, though, is that the device also offers the option of patient-activated event recording, which can aid diagnosis by establishing the type of correlation that exists between the patient's heart rhythm and symptoms. In more than 90% of cases, further follow-up investigations will allow the physician to establish with certainty whether the patient's symptoms are caused by cardiac events. In certain cases, this diagnostic strategy may also be combined with home monitoring (the remote monitoring of recorded data).


Treatment step-by-step

  • Heart disease is confirmed or ruled out as being responsible for symptoms
  • Treatment of acute disease
  • Drug-based treatment is reviewed or expanded
  • An assessment is carried out with regard to patient's suitability for treatment using an implantable device; selection of the type of implantable pacing device to suit the patient's requirements; information and consent procedure, including discussion with the patient and written consent
  • Implantation
  • Management and programming of the device; consultation with the patient; an outpatient follow-up appointment is scheduled
  • Regular follow-up appointments either with the outpatient department or a local specialist; home (remote) monitoring where appropriate

Articles on implantable cardiac pacing devices

Seifert M, Schau T, Moeller V, Neuss M, Meyhoefer J, Butter C:
Influence of pacing configurations, body mass index, and position of coronary sinus lead on frequency of phrenic nerve stimulation and pacing thresholds under cardiac resynchronization therapy. Europace. 2010 Jul;12(7):961-7. Epub 2010 May 5

Seifert M, Hoffmann J, Meyhöfer J, Butter C:
[Improving left ventricular contractility by stimulation during the absolute refractory period - cardiac contractility modulation (CCM)]. Herzschrittmacherther Elektrophysiol. 2008 Dec;19 Suppl 1:69-76. German

M. Seifert, M. Schlegl, W. Hoersch, E. Fleck, A. Doelger, C. Butter:
Functional capacity and Changes of the Neurohormonal and Cytokine Status after Long-term Cardiac Resynchronization Therapy in CHF Patients. Int J Cardiol. 2007 Jun 19

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