Experiences with phrenic nerve pacing in children.

We report a series of four spinal cord-injured children with ventilator dependency who were implanted with radiofrequency phrenic nerve pacers. At injury, their ages ranged from 6 to 9 years. Implantation occurred from 15 to 47 months following injury. The longest term of pacing has been 59 months. One patient, who was being paced full-time, died suddenly at 32 months of a viral myocarditis. Two patients underwent bipolar phrenic implantation in the neck, while two other patients underwent bilateral thoracotomy with monopolar electrode implantation in the mediastinum. There have been no complications related to pacer dysfunction in the postoperative course. Selective pacing schedules have been developed to minimize problems related with external mechanical ventilation. Radiofrequency phrenic nerve pacing is of value in the complete rehabilitative management of these severely disabled children.