Breathing Pacemakers for Diaphragm Paralysis

What is a Diaphragm Pacemaker?

A breathing pacemaker controls activity in the diaphragm muscle, the primary muscle of breathing. Electrodes implanted around the nerves to the diaphragm (phrenic nerves), or placed directly into the muscle cause an inspiratory (inhalation) event to occur.

How Does a Diaphragm Pacemaker Work?

An external transmitter sends a signal through the implanted electrodes causing the diaphragm to contract. The contraction mimics the activity that occurs with normal breathing. Exhalation occurs passively in response to the inhaled air.

Who May Benefit from a Diaphragm Pacemaker?

The Institute for Advanced Reconstruction is one of the only places worldwide that performs diaphragm pacemaker implantation in select patients with unilateral or bilateral diaphragm paralysis due to phrenic nerve injury, which assists in successfully restoring breathing muscle activity. We have vast experience in combining pacemakers with nerve reconstruction to optimize recovery in the most complex cases of diaphragm paralysis. Our work has been published in numerous medical journals and several online and print textbooks (Rehabilitative Surgery, Difficult Decisions in Thoracic Surgery).

Although breathing pacemakers are FDA approved for spinal cord injury, we comply with medical standards in the off-label use of this device to restore function in patients with severe cases of phrenic nerve injury and diaphragm paralysis. Please click the link to see video testimonials from several of our patients who have had this procedure.

A diaphragm pacemaker also provides ventilatory support for patients with certain conditions, such as high spinal cord injury and ALS (Lou Gerhig’s disease), when the diaphragm no longer functions independently. Many of these patients are on a ventilator or are chronically dependent on oxygen therapy. Other conditions for which diaphragm pacemakers may be effective include sleep apnea, spinal cord stenosis, central nervous system disorders, and stroke.

What are the Advantages of Diaphragm Pacemakers over Mechanical Ventilation?

Breathing pacemakers provide respiratory function superior to mechanical ventilators since with pacemakers, the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure. This is physiologically more accurate and comfortable for the patient.

Pacing patients are at much lower risk of upper airway infections including ventilator-associated pneumonia (VAP) due to the reduction in suctioning, elimination of external humidifier and ventilator circuits, and the potential removal of the tracheostomy tube in appropriate patients.

Breathing pacemakers are small, and do not require the bulky tubing and batteries of mechanical ventilators, so the patient’s mobility is greatly enhanced. The silent operation of a breathing pacemaker greatly enhances the patient’s ability to participate in social and educational environments.

Most patients strongly prefer pacing over mechanical ventilation for a variety of reasons such as normal breathing and speech patterns, ease of eating and drinking and improved sense of smell.

Breathing pacemakers generally cost less than $1,000 per year in disposable supplies (antennas, batteries, etc.) to operate, which is substantially less than the rental fees and disposable supplies associated with a mechanical ventilator. On average, a breathing pacemaker will pay for itself in roughly 2 years and save over $20,000 per year thereafter.

Breathing pacemakers can be implanted using a variety of minimally-invasive surgical approaches, usually through a small neck incision or laparoscopically through the abdomen. For certain patients, the pacemaker procedure can even be performed on an outpatient basis. For others, breathing pacemakers can be used in conjunction with intercostal or spinal accessory nerve grafting to restore diaphragm function and allow pacing in patients who otherwise would not be candidates.

Why Choose The Institute for Advanced Reconstruction for Diaphragm Pacemaker Surgery?

At The Institute for Advanced Reconstruction our world renowned phrenic nerve and diaphragm pacemaker surgeons have tremendous experience implanting both of the FDA-approved diaphragm pacemakers available in the U.S. ( We are a designated Synapse Center, and one of the busiest in the United States. Our in-depth knowledge of each product can be shared with you to assist in choosing the right device for your particular condition and set of circumstances.

We are the only center in the world with extensive experience in performing nerve grafts in conjunction with placement of diaphragm pacemakers for those select patients that would otherwise not be candidates for ventilator weaning procedures. For this reason, we are a referral center for the most difficult and challenging cases of ventilator dependency from throughout the United States and abroad.

More Information

Contact us today for more information about breathing pacemakers for diaphragm paralysis.

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