title: [Phrenic nerve stimulation in biventricular cardiac pacemakers].
abstract: 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.
authors.affiliation: Chirurgische Abteilung, Allgemeines öffentliches Krankenhaus der Elisabethinen, Fadingerstrasse 1, Linz, Austria. th.schwierz@gmx.at
authors.forename: T
authors.initials: T
authors.lastname: Schwierz
authors.forename: S
authors.initials: S
authors.lastname: Winter
authors.forename: H
authors.initials: H
authors.lastname: Pürerfellner
authors.forename: F
authors.initials: F
authors.lastname: Tomaselli
authors.forename: H-J
authors.initials: HJ
authors.lastname: Nesser
authors.forename: R
authors.initials: R
authors.lastname: Függer
mesh_terms: 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