[Present status and future aspects of the respiratory pacemaker].

Under certain conditions, phrenic pacing is a rare but most effective and attractive alternative for long-term ventilation. General indications concern diseases of the breathing center, for example Undine's disease (loss of CO2 sensitivity) in infants and high cervical spinal cord lesions in the level of C0 to C3. Despite of the advantage of physiologic respiration mode (no positive air pressure) compared to long-term ventilation, the phrenic pacemaker enables high life quality for the patients due to possibilities of closing of tracheostoma (Vienna system), an optimum in mobility and high cost effectiveness. International research and development in this area concerns 1. nerve transposition of an innervated nerve to a denervating phrenic nerve, 2. additional stimulation of thoracal muscles for inspiration, 3. additional stimulation of expiration, 4. endoscopic operative positioning of the electrodes, 5. development of a pacer with sensor input for an individual respiration rhythm (controlled by the vocal cord) and 6. development of a fully implantable system Improvements of the present pacemaker system may lead to enlargement of indications, for example use in patients with severe nocturnal arrhythmias in respiration.