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Related Experiment Video

Updated: Apr 28, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Phrenic nerve stimulation in cardiac resynchronization therapy.

Ghassan Moubarak1, Abdeslam Bouzeman, Jacky Ollitrault

  • 1Department of Pacing and Interventional Electrophysiology, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France, ghassan.moubarak@gmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|June 18, 2014
PubMed
Summary
This summary is machine-generated.

Phrenic nerve stimulation (PNS) during cardiac resynchronization therapy (CRT) affects 2-37% of patients. New quadripolar leads and electronic repositioning effectively manage PNS, reducing the need for invasive procedures.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Neuromuscular Stimulation

Background:

  • Phrenic nerve stimulation (PNS) is an incidental complication of cardiac resynchronization therapy (CRT) due to left ventricular (LV) lead electrical impulses.
  • PNS prevalence ranges from 2% to 37% and is not always detected during supine implantation procedures.

Purpose of the Study:

  • To review the incidence, risk factors, clinical impact, and management strategies for PNS in CRT patients.
  • To highlight recent advancements in managing PNS, focusing on non-invasive and lead-based solutions.

Main Methods:

  • Review of current literature on PNS in CRT.
  • Analysis of risk factors including lead position (lateral/posterior veins, apical placement) and stimulation thresholds.
  • Evaluation of management techniques: lead mapping, alternative pacing configurations, non-invasive adjustments (output reduction, pulse duration, electronic repositioning), and quadripolar lead capabilities.

Main Results:

  • Higher risk of PNS is associated with lateral/posterior veins and apical lead positions.
  • Management options include lead repositioning, alternative pacing, and non-invasive adjustments.
  • Quadripolar leads offer superior PNS mitigation through multiple pacing configurations and electronic repositioning, addressing most clinical cases.

Conclusions:

  • PNS is a significant complication in CRT, influenced by lead placement and electrical parameters.
  • Advanced management strategies, particularly electronic repositioning with quadripolar leads, effectively mitigate PNS.
  • These innovations reduce the need for invasive lead revision or abandoning CRT, improving patient outcomes.