[Phrenic nerve stimulation in biventricular cardiac pacemakers].
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.
Schwierz
T
T
Chirurgische Abteilung, Allgemeines öffentliches Krankenhaus der Elisabethinen, Fadingerstrasse 1, Linz, Austria. th.schwierz@gmx.at
Winter
S
S
Pürerfellner
H
H
Tomaselli
F
F
Nesser
H-J
HJ
Függer
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054326:Coronary Sinus / Q000503:physiopathology; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010138:Pacemaker, Artificial; D010791:Phrenic Nerve / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors