title: Intrathoracic phrenic pacing: a 10-year experience in France.
abstract: BACKGROUND
  Phrenic pacing is an alternative to positive-pressure ventilation in selected patients, mostly in cases of upper spinal cord injury. We evaluated results of phrenic pacing performed by video-assisted thoracic surgery (VATS).
  
  
  METHODS
  Between 1997 and 2007, after complete neuromuscular investigations, 20 patients requiring full-time ventilation were selected for phrenic pacing (19 with posttraumatic tetraplegia and 1 with congenital central hypoventilation syndrome). Quadripolar cuff electrodes were fixed around each intrathoracic phrenic nerve via bilateral VATS. They were connected to a subcutaneous radiofrequency receiver coupled to an external radiofrequency transmitter. All patients participated in a reconditioning program beginning 2 weeks after implantation and continued until ventilatory weaning.
  
  
  RESULTS
  Phrenic pacing was successful in all cases. No intraoperative complications or perioperative mortality were observed. Intraoperative testing detected stimulation thresholds in 19 patients (range, 0.05-2.9 mA). Ventilatory weaning was obtained in 18 patients. Median diaphragm reconditioning time was 6 weeks (2 weeks-11 months). Reconditioning was still in process in a young woman and was not achieved in an elderly woman with a 4-year history of tetraplegia. All the patients weaned from mechanical ventilation reported improved quality of life. Failure or delay in recovery of effective diaphragm contraction was due to nonreversible amyotrophy.
  
  
  CONCLUSIONS
  VATS implantation of 4-pole electrodes around the intrathoracic phrenic nerve is a safe procedure. Ventilatory weaning correlates with the degree of diaphragmatic amyotrophy. Phrenic pacing, performed as soon as neurologic and orthopedic stabilization is achieved, is the most important prognostic factor for successful weaning.
authors.affiliation: Department of Thoracic Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France. francoise.lepimpec-barthes@egp.aphp.fr
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec-Barthes
authors.forename: Jésus
authors.initials: J
authors.lastname: Gonzalez-Bermejo
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Hubsch
authors.forename: Alexandre
authors.initials: A
authors.lastname: Duguet
authors.forename: Capucine
authors.initials: C
authors.lastname: Morélot-Panzini
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
mesh_terms: D002574:Cervical Vertebrae; D003964:Diaphragm / Q000502:physiology; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D010791:Phrenic Nerve / Q000502:physiology*; D011183:Postoperative Complications; D011184:Postoperative Period; D012133:Respiratory Paralysis / Q000628:therapy*; D020182:Sleep Apnea, Central / Q000628:therapy; D013119:Spinal Cord Injuries / Q000628:therapy; D020775:Thoracic Surgery, Video-Assisted; D015300:Ventilator Weaning / Q000379:methods*