[Phrenic nerve stimulation in biventricular cardiac pacemakers]

Area of Science:

• Cardiology
• Medical Device Technology
• Electrophysiology

Background:

• Phrenic nerve stimulation (PNS) presents a significant challenge during left ventricle lead implantation for cardiac rhythm management devices.
• A standardized, step-by-step protocol is crucial for effectively managing and correcting PNS during implantation procedures.

Purpose of the Study:

• To present a practical, step-by-step methodology for correcting phrenic nerve stimulation encountered during left ventricle lead implantation.
• To evaluate the incidence, successful correction rates, and long-term outcomes of this approach.

Main Methods:

• Retrospective analysis of 266 left ventricle lead positions.
• Detailed documentation of phrenic nerve stimulation incidence and correction strategies.
• Multivariate analysis to identify factors influencing PNS and assess long-term results (median 27 months).

Main Results:

• Phrenic nerve stimulation (PNS) was observed in 13.9% of lead implantations.
• PNS incidence was significantly correlated with the stimulation site (coronary sinus side branch), but not lead type, CRT indication, or patient sex.
• The presented step-by-step approach achieved satisfactory correction of PNS in all affected cases.

Conclusions:

• A systematic, step-by-step approach is effective in managing phrenic nerve stimulation during left ventricle lead implantation.
• Strategies include lead repositioning, changing lead type, or utilizing devices with electronic repositioning capabilities.
• Successful correction of PNS ensures optimal lead function and patient outcomes.