Transvenous phrenic nerve stimulation in patients with Cheyne-Stokes respiration and congestive heart failure: a safety and proof-of-concept study.
BACKGROUND
Cheyne-Stokes respiration (CSR), which often occurs in patients with congestive heart failure (CHF), may be a predictor for poor outcome. Phrenic nerve stimulation (PNS) may interrupt CSR in patients with CHF. We report the clinical use of transvenous PNS in patients with CHF and CSR.


METHODS
Nineteen patients with CHF and CSR were enrolled. A single stimulation lead was placed at the junction between the superior vena cava and brachiocephalic vein or in the left-side pericardiophrenic vein. PNS stimulation was performed using Eupnea System device (RespiCardia Inc). Respiratory properties were assessed before and during PNS. PNS was assessed at a maximum of 10 mA.


RESULTS
Successful stimulation capture was achieved in 16 patients. Failure to capture occurred in three patients because of dislocation of leads. No adverse events were seen under maximum normal stimulation parameters for an overnight study. When PNS was applied following a series of central sleep apneic events, a trend toward stabilization of breathing and heart rate as well as improvement in oxygen saturation was seen. Compared with pre-PNS, during PNS there was a significant decrease in apnea-hypopnea index (33.8 ± 9.3 vs 8.1 ± 2.3, P = .00), an increase in mean and minimal oxygen saturation as measured by pulse oximetry (89.7% ± 1.6% vs 94.3% ± 0.9% and 80.3% ± 3.7% vs 88.5% ± 3.3%, respectively, all P = .00) and end-tidal CO2 (38.0 ± 4.3 mm Hg vs 40.3 ± 3.1 mm Hg, P = .02), but no significant difference in sleep efficiency (74.6% ± 4.1% vs 73.7% ± 5.4%, P = .36).


CONCLUSIONS
The preliminary results showed that in a small group of patients with CHF and CSR, 1 night of unilateral transvenous PNS improved indices of CSR and was not associated with adverse events.
Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xi-Long
XL
Zhang
Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Ning
N
Ding
Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Surgery, and Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
Hong
H
Wang
Department of Cardiology, Medical School, Ohio State University, Columbus, OH.
Ralph
R
Augostini
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Bing
B
Yang
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Di
D
Xu
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Weizhu
W
Ju
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xiaofeng
X
Hou
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Xinli
X
Li
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Buqing
B
Ni
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Kejiang
K
Cao
Division of Cardiothoracic Surgery, Columbia University, New York, NY.
Isaac
I
George
Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Jie
J
Wang
Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: shijiangzhang@hotmail.com.
Shi-Jiang
SJ
Zhang
D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D002639:Cheyne-Stokes Respiration / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve; D017286:Polysomnography; D011446:Prospective Studies; D016896:Treatment Outcome