Laryngeal pacemaker. Part I. Electronic pacing of reinnervated strap muscles in the dog

The best approach to management of bilateral vocal cord paralysis, with its resultant airway compromise, has not yet been universally agreed upon. Recently proposed methods have included direct stimulation of the laryngeal dilators by the modulation of rhythmic information from the chest wall, diaphragm, phrenic nerve, or accessory muscles of respiration. In such an approach, the information obtained is not necessarily related to inspiration only, and direct implantation of a stimulating electrode into the laryngeal musculature may not be fully efficient and tolerated over time. To obviate such difficulties, the authors propose to broaden the concept of electrical pacing by (1) developing a better source for the triggering of electrical activity during inspiration and (2) devising a reliable means of long-term physiologic stimulation of denervated striated muscle not subject to deterioration over time. Such an experimental unit was constructed in the canine. It is based on afferent information that originates from the mechanical lengthening of the trachea during inspiration and is detected through a linear strain gauge sutured to the tracheal rings. The signal obtained is modulated through an impedance detector and is amplified. An efferent limb consisting of a monopolar cuffed electrode placed around a crossover nerve-muscle pedicle from one sternohyoid muscle to the other was used successfully. Such a preliminary experiment with a strap muscle avoids the extraneous factors related to function of the paralyzed larynx. Successful nerve-muscle pedicle pacing, synchronous with respiration, was verified through electromyographic recordings and direct observation in all animals studied.