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Updated: Feb 6, 2026

Nerve Stimulator-guided Injection of Autologous Stem Cells Near the Equine Left Recurrent Laryngeal Nerve
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Heart on a string: a novel approach to managing difficult access to the left pericardiacophrenic vein for phrenic

Dennis Lawin1, Bert Hansky1, Philipp Baumann1

  • 1Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bielefeld Mitte, Teutoburger Straße 50, 33604, Bielefeld, Germany.

Herzschrittmachertherapie & Elektrophysiologie
|August 22, 2018
PubMed

Insights

Transvenous phrenic nerve stimulation for heart failure patients with central sleep apnea can be challenging. This case study demonstrates a novel technique using collateral vessels to successfully implant a pacing lead.

Area of Science:

  • Cardiology
  • Neurology
  • Sleep Medicine

Background:

  • Central sleep apnea (CSA) is a serious condition often associated with heart failure.
  • Phrenic nerve stimulation (PNS) offers a promising treatment for CSA.
  • Transvenous lead implantation for PNS can be technically challenging due to complex venous anatomy.

Observation:

  • Direct cannulation of the left pericardiacophrenic vein (PPV) for lead placement failed due to vessel tortuosity.
  • An alternative approach utilizing the inferior phrenic vein (IPV) was employed.
  • A guide catheter was used to intubate the IPV, which drains into the inferior vena cava.

Findings:

  • A guidewire was successfully advanced retrogradely from the IPV to the left PPV and brachiocephalic vein.
  • A snare catheter captured the guidewire, stabilizing the heart and facilitating lead placement.
  • This technique overcame anatomical challenges for successful transvenous lead implantation.

Implications:

  • This case illustrates an effective strategy for overcoming difficulties in lead implantation for transvenous PNS.
  • Knowledge of collateral venous pathways is crucial for successful device implantation in complex cases.
  • This approach may improve the feasibility and success rates of PNS therapy for heart failure patients with CSA.

Keywords:
Central sleep apneaHeart failureInferior phrenic veinPericardiacophrenic veinPhrenic nerve stimulation

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