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Updated: May 26, 2026
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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Thoracoscopic patch insulation to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy
Neeraj Mediratta1, Diane Barker, James McKevith
1Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
Summary
Phrenic nerve stimulation from cardiac resynchronization therapy leads can cause diaphragmatic twitch. Surgical insulation of the phrenic nerve using a pericardial patch via VATS resolves this, allowing continued CRT benefits.
Area of Science:
- Cardiology
- Thoracic Surgery
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) improves heart failure outcomes.
- Left ventricular (LV) lead placement for CRT can cause phrenic nerve stimulation, leading to diaphragmatic twitch.
- Venous anatomy often dictates LV lead positioning, posing challenges.
Observation:
- Phrenic nerve stimulation by LV pacing leads causes uncomfortable diaphragmatic twitch.
- Standard methods like reprogramming or lead repositioning may not always resolve stimulation.
- A novel VATS procedure for surgical insulation of the phrenic nerve was performed.
Findings:
- Surgical insulation of the phrenic nerve with a bovine pericardium patch successfully eliminated diaphragmatic twitch.
- The minimally invasive VATS procedure was a short-stay, complication-free intervention.
- The patient experienced improved heart failure symptoms (NYHA Class III to II) and continued CRT benefits.
Implications:
- Thoracoscopic surgical patch insulation offers a solution for CRT lead-induced phrenic nerve stimulation.
- This technique can enable CRT in patients previously limited by lead placement issues.
- It allows patients to continue receiving CRT benefits without diaphragm-related complications.
