Document Detail

Thoracoscopic patch insulation to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy.
MedLine Citation:
PMID:  22186779     Owner:  NLM     Status:  Publisher    
AimsCardiac resynchronization therapy is an established therapy for heart failure, improving quality of life and prognosis. Despite advances in technique, available leads and delivery systems, trans-venous left ventricular (LV) lead positioning remains dependent on the patient's underlying venous anatomy. The left phrenic nerve courses over the surface of the pericardium laterally and may be stimulated by the LV pacing lead, causing uncomfortable diaphragmatic twitch. This paper describes a video-assisted thoracoscopic (VATS) procedure to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy.Methods and resultsMost current ways of avoiding phrenic stimulation involve either electronic reprogramming to distance the phrenic nerve from the stimulation circuit or repositioning the lead. We describe a case where the phrenic nerve was surgically insulated from the stimulating current by insinuating a patch of bovine pericardium between the epicardium and native pericardium of the heart thus completely resolving previously intolerable and incessant diaphragmatic twitch. The procedure was performed under general anaesthesia with single-lung ventilation and minimal use of neuromuscular blocking agents. Surgical patch insulation of the phrenic nerve was performed using minimally invasive VATS surgery, as a short-stay procedure, with no complications. No diaphragmatic twitch occurred post-surgery and the patient continued to gain symptomatic benefit from cardiac synchronization therapy (New York Heart Association Class III to II), enabling return to work.ConclusionsIn cases where the trans-venous position of a LV lead is limited by troublesome phrenic nerve stimulation, thoracoscopic surgical patch insulation of the phrenic nerve could be considered to allow beneficial cardiac resynchronization therapy.
Neeraj Mediratta; Diane Barker; James McKevith; Peter Davies; Sandra Belchambers; Archana Rao
Related Documents :
18414389 - Cellular and molecular mechanisms responsible for the action of testosterone on human s...
15086789 - Membrane traffic in skeletal muscle.
2983679 - Extracellular-matrix synthesis by skeletal muscle in culture. major secreted collagenou...
20921089 - Skeletal muscle myoblasts possess a stretch-responsive local angiotensin signalling sys...
19804579 - The role of systemic inflammation in age-related muscle weakness and wasting.
9934419 - Effects of therapeutic ultrasound on the regeneration of skeletal myofibers after exper...
23125929 - Entrapment neuropathies in the upper and lower limbs: anatomy and mri features.
17618759 - Levator ani muscle and connective tissue changes associated with pelvic organ prolapse,...
2353419 - Morphometric analyses of the skin of dogs with atopic dermatitis and correlations with ...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-19
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Oral amiodarone provoking inferior ST elevation and unmasking Brugada-like electrocardiogram feature...
Next Document:  The role of ADP-ribosylation in regulating DNA double-strand break repair.