Breathing Pacemakers

System Details

The Avery Biomedical Breathing Pacemaker System is a phrenic nerve stimulator, also called a diaphragm pacemaker. It consists of surgically implanted receivers and electrodes mated to an external transmitter by antennas worn over the implanted receivers. Phrenic pacing provides ventilatory support for patients with chronic respiratory insufficiency whose diaphragm, lungs, and phrenic nerves have residual function.

Mark IV Transmitter

Mark IV Transmitter

In March 1998, the U.S. Food and Drug Administration gave premarket approval (PMA) to the new Mark IV external transmitter for adult and pediatric patients who have lost neurological control of respiration. FDA premarket approval is required before Class III medical devices can be commercially distributed in the United States.

In advance of FDA approval, the Mark IV had been distributed in 24 countries worldwide. The Mark IV qualified for the CE Mark under the European Active Implantable Medical Device Directive in 1994.

Receivers and Electrodes

The implanted receiver is a small electronic device, about the size of a US quarter and approximately 1/4″ thick, that receives radiofrequency energy and converts it to electrical impulses which stimulate the diaphragm.

The implanted electrode is a highly flexible stainless steel wire, insulated by silicone rubber, with a platinum nerve contact on one end, and a connector that mates with the receiver at the other.

Transtelephonic Monitor


The Transtelephonic Monitoring (TTM) data transmitter can provide quantitative data for routine and diagnostic monitoring of the external and implanted diaphragm pacing equipment as well as the patient’s physiological response to stimulation.

Using an ordinary telephone, a signal can be sent to us twenty-four hours a day from anywhere in the world. The transmitted data is recorded so that analysis can be done during the business day. A report of every TTM signal with analysis comments is sent to the patient’s physician to assist in medical diagnosis and treatment.

Instructions for sending a TTM report can be found in the Instruction Manual provided with each system and summarized here.


An external antenna is worn over each implanted receiver and sends power and radio signals from the transmitter to the receiver transcutaneously. This radiofrequency coupled design means that there are no wires or plugs protruding from the skin, and no batteries in the implant that would require periodic replacement.

An antenna is a durable disposable item which requires periodic replacement. It is recommended that antennas be replaced prophylactically every six months. Antennas are available in one-meter and two-meter lengths.

Antennas do not contain latex. Additionally, no latex products are used in their manufacturing. Instructions for the use and care of antennas can be found here.