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Updated: Feb 2, 2026

Preparation of Peripheral Nerve Stimulation Electrodes for Chronic Implantation in Rats
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Thoracoscopic Patch Insulation for Phrenic Nerve Stimulation after Permanent Pacemaker Implantation.

Yoonjin Kang1, Eung Rae Kim2, Jae Gun Kwak1

  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine.

The Korean Journal of Thoracic and Cardiovascular Surgery
|November 8, 2018
PubMed
Summary

Unintended phrenic nerve stimulation is a pacemaker complication. Thoracoscopic phrenic nerve insulation using a Gore-Tex patch effectively treated persistent diaphragmatic stimulation in a teenage patient.

Keywords:
Artificial pacemakersMinimally invasive surgical proceduresPhrenic nerveThoracoscopy

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Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Biomedical Engineering

Background:

  • Permanent pacemaker implantation can lead to unintended phrenic nerve stimulation, causing discomfort.
  • This complication involves diaphragm twitching synchronous with pacing.
  • Reprogramming the pacemaker may not always resolve the issue.

Observation:

  • A 15-year-old boy experienced chest discomfort due to phrenic nerve stimulation from his permanent pacemaker.
  • Diaphragmatic stimulation persisted despite attempts to reprogram the device.
  • This indicated a need for an alternative intervention.

Findings:

  • Phrenic nerve insulation using a Gore-Tex patch was performed thoracoscopically.
  • The minimally invasive procedure successfully insulated the phrenic nerve from the pacemaker lead.
  • This resolved the patient's symptoms of diaphragmatic stimulation.

Implications:

  • Thoracoscopic phrenic nerve insulation is a viable and minimally invasive treatment for refractory phrenic nerve stimulation.
  • This technique offers a solution for pacemaker complications previously managed with less targeted approaches.
  • Further research could explore long-term efficacy and broader application of this insulation method.