A Rare Instance of ‘Cardio-Respiratory Pacing’: Permanent Pacemaker Insertion for Symptomatic Bradycardia in a Quadriplegic Man Dependent on Diaphragmatic Pacing by Phrenic Nerve Stimulators

Abstract

Patients with high spinal cord injury may present with significant cardiac dysautonomia. There is a dearth of data regarding electromechanical interference to cardiac pacemakers from phrenic nerve stimulators which are used in such patients for respiratory support. We report an instance of bipolar lead permanent pacemaker insertion for ventricular standstill in a man with quadriplegia following C2 fracture and the measures we adopted to minimise electromagnetic interference with phrenic nerve stimulators. To the best of our knowledge, this is the first reported instance of successful pacemaker insertion in a quadriplegic patient on long-term diaphragmatic pacing.