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Transvenous Phrenic Nerve Stimulation in Patients with Cheyne-Stokes Respiration and Congestive Heart Failure: A Safety and Proof-of-Concept Study.
MedLine Citation:
PMID:  22302299     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract: BACKGROUND:Cheyne-Stokes respiration (CSR) is often occurred in patients with congestive heart failure (CHF) and 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 CHF patients with CSR. METHODS:Nineteen CHF patients with 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 (RespiCardia Inc., Minnetonka, MN, USA). Respiratory properties were assessed prior to and post-PNS. PNS was assessed at a maximum of 10 mA. RESULTS:Successful stimulation capture was achieved in 16 patients. Failure to capture occurred in 3 patients due to 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 towards stabilization of breathing and heart rate, as well as improvement in oxygen saturation, were seen. Compared with pre-PNS, during PNS there was a significant decrease in indices of apnea/hypopnea (33.8±9.3 vs 8.1±2.3, P = 0.00), increase in mean and minimal pulse oxygen saturation (89.7±1.6 % vs 94.3±0.9% and 80.3±3.7% vs 88.5±3.3%, all P = 0.00), and end-tidal carbon dioxide (ETCO(2)) (38.0±4.3mmHg vs 40.3±3.1mmHg, P =0.02), but no significant difference in sleep efficiency (74.6±4.1% vs 73.7±5.4%, P =0.36). CONCLUSIONS:The preliminary results showed that in a small group of patients with HF and CSR, one night of unilateral transvenous PNS improved indices of CSR and was not associated with adverse events.Clinical trial:Feasibility Study to Determine the Effects of Phrenic Nerve Stimulation in Patients with Periodic Breathing.Number: NCT00909259.
Authors:
Xi-Long Zhang; Ning Ding; Hong Wang; Ralph Augostini; Bing Yang; Di Xu; Weizhu Ju; Xiaofeng Hou; Xinli Li; Buqing Ni; Kejiang Cao; Isaac George; Jie Wang; Shi-Jiang Zhang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-2
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From Department of Respirology (Drs Xi-Long Zhang, Ning Ding and Hong Wang), Department of Cardiology (Drs Bing Yang, Di Xu, Weizhu Ju, Xiaofeng Hou, Xinli Li, Kejiang Cao and Jie Wang) and Department of Cardiothoracic Surgery (Drs Shi-Jiang Zhang and Buqing Ni), The First Affiliated Hospital of Nanjing Medical University; Nanjing, China; and Department of Cardiology (Dr. Ralph Augostini), Medical School, Ohio State University, Columbus, Ohio, USA, and Division of Cardiothoracic Surgery, Department of Surgery (Dr. Isaac George) and Division of Cardiology, Department of Medicine (Dr. Jie Wang), College of Physicians and Surgeons Columbia University, New York, USA.
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