title: Transvenous phrenic nerve stimulation for the treatment of central sleep apnoea in heart failure.
abstract: OBJECTIVE
  Periodic breathing with central sleep apnoea (CSA) is common in heart failure patients and is associated with poor quality of life and increased risk of morbidity and mortality. We conducted a prospective, non-randomized, acute study to determine the feasibility of using unilateral transvenous phrenic nerve stimulation for the treatment of CSA in heart failure patients.
  
  
  RESULTS
  Thirty-one patients from six centres underwent attempted transvenous lead placement. Of these, 16 qualified to undergo two successive nights of polysomnography-one night with and one night without phrenic nerve stimulation. Comparisons were made between the two nights using the following indices: apnoea-hypopnoea index (AHI), central apnoea index (CAI), obstructive apnoea index (OAI), hypopnoea index, arousal index, and 4% oxygen desaturation index (ODI4%). Patients underwent phrenic nerve stimulation from either the right brachiocephalic vein (n = 8) or the left brachiocephalic or pericardiophrenic vein (n = 8). Therapy period was (mean ± SD) 251 ± 71 min. Stimulation resulted in significant improvement in the AHI [median (inter-quartile range); 45 (39-59) vs. 23 (12-27) events/h, P = 0.002], CAI [27 (11-38) vs. 1 (0-5) events/h, P≤ 0.001], arousal index [32 (20-42) vs. 12 (9-27) events/h, P = 0.001], and ODI4% [31 (22-36) vs. 14 (7-20) events/h, P = 0.002]. No significant changes occurred in the OAI or hypopnoea index. Two adverse events occurred (lead thrombus and episode of ventricular tachycardia), though neither was directly related to phrenic nerve stimulation therapy.
  
  
  CONCLUSIONS
  Unilateral transvenous phrenic nerve stimulation significantly reduces episodes of CSA and restores a more natural breathing pattern in patients with heart failure. This approach may represent a novel therapy for CSA and warrants further study.
authors.affiliation: 4th Military Hospital, Wroclaw, Poland. piotrponikowski@4wsk.pl
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Javaheri
authors.forename: Dariusz
authors.initials: D
authors.lastname: Michalkiewicz
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Bart
authors.forename: Danuta
authors.initials: D
authors.lastname: Czarnecka
authors.forename: Marek
authors.initials: M
authors.lastname: Jastrzebski
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kusiak
authors.forename: Ralph
authors.initials: R
authors.lastname: Augostini
authors.forename: Dariusz
authors.initials: D
authors.lastname: Jagielski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Witkowski
authors.forename: Rami N
authors.initials: RN
authors.lastname: Khayat
authors.forename: Olaf
authors.initials: O
authors.lastname: Oldenburg
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Thomas
authors.initials: T
authors.lastname: Bitter
authors.forename: Rehan
authors.initials: R
authors.lastname: Karim
authors.forename: Conn
authors.initials: C
authors.lastname: Iber
authors.forename: Ayesha
authors.initials: A
authors.lastname: Hasan
authors.forename: Karl
authors.initials: K
authors.lastname: Hibler
authors.forename: Robin
authors.initials: R
authors.lastname: Germany
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
mesh_terms: D000368:Aged; D001143:Arousal / Q000502:physiology; D004599:Electric Stimulation Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010791:Phrenic Nerve; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen