Transvenous phrenic nerve stimulation improves Cheyne-Stokes respiration in patients with chronic heart failure
European Respiratory Journal(2011)
Abstract
Background: Cheyne-Stokes respiration (CSR) may accelerate progression of congestive heart failure (CHF) and is associated with poor survival. Phrenic nerve stimulation (PNS) may interrupt CSR and improve CHF outcomes. We report the first clinical use of transvenous PNS in CHF patients with CSR. Methods: 23 CHF patients with central sleep apnea 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 pericardiophrenic vein. PNS stimulation was performed using the Eupnea System software. Respiratory properties were assessed prior to and post-PNS. PNS was assessed at a maximum of 10 mA. Results: No adverse events were seen under maximum normal stimulation parameters for a maximum single 12 hour sleep cycle. Phrenic nerve stimulation was able to reproducibly slow the rate of breathing in a predictable manner and raise end-tidal expiratory CO 2 . When PNS was applied following a series of central sleep apneic events, a trend towards stabilization of breathing and heart rate, as well as improvement in oxygen saturation, was seen.There was a significant improvement in indices of apnea/hypopnea, central apnea, oxygen saturation and sleep efficiency after PNS versus pre-PNS (all P Conclusion: Unilateral transvenous PNS proved to be a safe and feasible treatment and by effectively improving CSR.
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Key words
transvenous phrenic nerve stimulation,chronic heart failure,heart failure,respiration,cheyne-stokes
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