Suitability of the Pericardiophrenic Veins for Phrenic Nerve Stimulation: An Anatomic Study

Bramante, Carolyn T.; Westlund, Randy; Weinhaus, Anthony J.

doi:10.1111/j.1525-1403.2011.00369.x

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…While the PPV ostium is most frequently on the floor of the LBC, some variability exists, and it can be located up to 40 degrees posteriorly or anteriorly. The PPV ranges in size from 3 to 6 Fr . Using puffs of contrast in the left anterior oblique (LAO) projection, the PPV ostium can be visualized in relation to the internal thoracic and left superior intercostal veins.…”

Section: Methodssupporting

confidence: 58%

How to implant a phrenic nerve stimulator for treatment of central sleep apnea?

Augostini

Afzal

Costanzo

et al. 2019

Cardiovasc electrophysiol

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Background Central sleep apnea (CSA) is a breathing disorder caused by the intermittent absence of central respiratory drive. Transvenous phrenic nerve stimulation is a new therapeutic option, recently approved by the FDA , for the treatment of CSA. Objective To describe the technique used to implant the transvenous phrenic nerve stimulation system (the remedē System, Respicardia, Inc). Methods The remedē System is placed in the pectoral region, typically on the right side. A single stimulation lead is placed in either the left pericardiophrenic vein (PPV) or the right brachiocephalic vein (RBC). A sensing lead is placed into the azygous vein to detect respiration. Results In the remedē System Pivotal trial, 147 of 151 (97%) patients were successfully implanted with the system. Sixty‐two percent of stimulation leads were placed in the PPV and 35% in the RBC. Mean procedure time was 2.7 ± 0.8 hours and 94% of patients were free from implant‐related serious adverse events through 6 months. Conclusion In patients with CSA, transvenous phrenic nerve stimulation is an effective and safe therapy with an implant procedure similar to that of cardiac implantable electronic devices.

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Section: Methodssupporting

confidence: 58%

How to implant a phrenic nerve stimulator for treatment of central sleep apnea?

Augostini

Afzal

Costanzo

et al. 2019

Cardiovasc electrophysiol

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“…They run along their respective sides of the heart together with the pericardiophrenic arteries and phrenic nerves and eventually drain into the brachiocephalic veins. While the right pericardiophrenic vein has been shown to be too small (< 0.5 mm diameter) or inconsistent for lead insertion and neurostimulation [4], the left pericardiophrenic vein, though also small (~2 mm diameter) [4], is easier to identify angiographically and to cannulate (. Fig.…”

Section: Device Description and Implantation Techniquementioning

confidence: 99%

A novel approach to the treatment of central sleep apnea in patients with heart failure

Augostini

2012

Herzschr. Elektrophys.

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Central sleep apnea (CSA) is a common, though often unrecognized, finding in congestive heart failure (HF) patients that is associated with poor quality of life and increased morbidity and mortality. While various treatment strategies, including continuous positive airway pressure (CPAP) therapy, have been devised and tested to treat CSA in HF, none thus far have been proven effective over the long term or been shown to improve survival. Adaptive pressure support servo-ventilation (ASV) is a promising potential new therapy for CSA, but like its predecessor, CPAP, it is often not well tolerated by patients, and results from clinical trials evaluating its long-term effectiveness in reducing morbidity and mortality are still a number of years off. Recently, a new therapy utilizing unilateral transvenous phrenic nerve stimulation has been introduced to treat CSA in HF. As a totally implantable, device-based therapy, it may be better tolerated than CPAP or ASV in HF patients and, thus, improve patient compliance with treatment. Early studies using this therapy have been encouraging, with patients demonstrating significant improvement in major indices of CSA severity.

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“…Phrenic nerve stimulation to pace the diaphragm is a technique whereby a nerve stimulator provides electrical stimulation of the phrenic nerve to cause diaphragmatic contraction. Before detailing the novel use of diaphragm pacing to prevent VIDD in mechanically ventilated patients in the ICU, it should be acknowledged that diaphragm pacing per se is not a novel therapeutic option: in fact, its first use in humans came in the late 1960s, and then the first phrenic nerve stimulators were made commercially available [24][25][26][27][28][29][30][31][32][33][34]. Although worldwide use is limited, the two main indications for phrenic nerve stimulation were, and still are, central alveolar hypoventilation and high quadriplegia [28][29][30][31][32][33][34].…”

Section: Potential Of Diaphragm Pacing To Prevent Vidd In the Icumentioning

confidence: 99%

State-of-the-Art Opinion Article on Ventilator-Induced Diaphragm Dysfunction: Update on Diagnosis, Clinical Course, and Future Treatment Options

et al. 2022

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Evidence from both animal and human studies now supports the development of ventilator-induced diaphragm dysfunction (VIDD) starting as early as 24 h after initiation of mechanical ventilation in the intensive care unit (ICU). However, although the concept of VIDD is now widely accepted, there remain several unanswered questions regarding its pathophysiology, rate of development, and (potentially) recovery after mechanical ventilation.This state-of-the-art opinion article briefly explains VIDD and provides an update on its clinical and prognostic relevance. It then focusses on state-of-the-art diagnostic approaches to determine diaphragm function, strength, and control (neural and peripheral), highlights knowledge gaps relevant to VIDD, and discusses the use of diaphragm pacing for VIDD prevention. It is suggested that future research projects in mechanically ventilated patients would ideally use both cortical and cervical phrenic nerve stimulation studies over time (including also diaphragm electromyography) as the gold standard techniques. This approach has not yet been utilized in a longitudinally designed study in the ICU. Application of these gold standard techniques would allow better understanding of the true pathophysiology and rate of development of VIDD. Notably, these techniques would be superior to diaphragm ultrasound, which yields surrogate markers of diaphragm function only without any direct measure of diaphragm strength or control. It is also suggested that such translational research would further advance understanding of diaphragm pacing as a very promising treatment option for VIDD.

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Suitability of the Pericardiophrenic Veins for Phrenic Nerve Stimulation: An Anatomic Study

Cited by 6 publications

References 31 publications

How to implant a phrenic nerve stimulator for treatment of central sleep apnea?

How to implant a phrenic nerve stimulator for treatment of central sleep apnea?

A novel approach to the treatment of central sleep apnea in patients with heart failure

State-of-the-Art Opinion Article on Ventilator-Induced Diaphragm Dysfunction: Update on Diagnosis, Clinical Course, and Future Treatment Options

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