Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2007
[Phrenic nerve stimulation in biventricular cardiac pacemakers].
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Schwierz T, Winter S, Pürerfellner H, Tomaselli F, Nesser H-J, Függer R
Аннотация
BACKGROUND: Phrenic nerve stimulation (PNS) complicates the positioning of the left ventricle lead. We present a step-by-step approach to correct PNS during implantation, as established in our daily routine.
METHODS: The incidence of PNS, its successful correction, and long-term results (median 27 months) were analyzed retrospectively in 266 lead positions.
RESULTS: Phrenic nerve stimulation occurred in 13.9% of the lead positions. Multivariate analysis (P<0.02) showed that PNS only depended on the place of stimulation (coronary sinus side branch). Lead type, CRT indication, and patient's sex had no significant correlation. Following the step-by-step approach presented here, PNS was corrected satisfactorily in all cases.
CONCLUSIONS: Approach in case of PNS: 1. push or pull the lead within the same vein, 2. change to a different vein, 3. maintain position in case of a safe distance between the phrenic nerve and the pacing threshold, 4. change the lead type to achieve stable anchorage at adequate positions, 5. use a device featuring electronic repositioning.
METHODS: The incidence of PNS, its successful correction, and long-term results (median 27 months) were analyzed retrospectively in 266 lead positions.
RESULTS: Phrenic nerve stimulation occurred in 13.9% of the lead positions. Multivariate analysis (P<0.02) showed that PNS only depended on the place of stimulation (coronary sinus side branch). Lead type, CRT indication, and patient's sex had no significant correlation. Following the step-by-step approach presented here, PNS was corrected satisfactorily in all cases.
CONCLUSIONS: Approach in case of PNS: 1. push or pull the lead within the same vein, 2. change to a different vein, 3. maintain position in case of a safe distance between the phrenic nerve and the pacing threshold, 4. change the lead type to achieve stable anchorage at adequate positions, 5. use a device featuring electronic repositioning.