Thoracoscopic phrenic nerve patch insulation to avoid phrenic nerve stimulation with cardiac resynchronization therapy

Abstract

A 76‐year‐old female was implanted with a cardiac resynchronization therapy (CRT) device, with the left ventricular lead implanted through a transvenous approach. One day after implantation, diaphragmatic stimulation was observed when the patient was in the seated position, which could not be resolved by device reprogramming. We performed thoracoscopic phrenic nerve insulation using a Gore‐Tex patch. The left phrenic nerve was carefully detached from the pericardial adipose tissue, and a Gore‐Tex patch was inserted between the phrenic nerve and pericardium using a thoracoscopic technique. This approach represents a potential option for the management of uncontrollable phrenic nerve stimulation during CRT.

Thoracoscopic Patch Insulation for Phrenic Nerve Stimulation after Permanent Pacemaker Implantation

“…Fibrotic change around the ventricle would have made it difficult to find another such position. There have been efforts to interpose Teflon felt or a patch between electrodes and the pericardium to stop diaphragmatic stimulation [ 1 , 3 , 4 ]. Phrenic nerve stimulation could be corrected by interposition of a Gore-Tex patch between the pericardium and electrodes rather than repositioning of the tip itself, the latter of which would pose a risk of perforation or bleeding.…”