Remedē Systems: Transvenous Pacing of the Phrenic Nerve

The remedē System (ZOLL Medical, Minnetonka, MN; Fig 1), which was approved by the Food and Drug Administration in October of 2017, is a transvenous device that stimulates the phrenic nerve for the treatment of central sleep apnea, which is often associated with heart failure and atrial fibrillation. Given the similarity in implantation procedure to pacemakers and implantable cardioverter/defibrillators, the remedē System implantation often occurs in the electrophysiology laboratory. Despite the transvenous nature and close proximity to cardiac structures on radiographic imaging, the remedē System does not have any cardiac pacing function/antiarrhythmia therapies, and it is important for an anesthesiologist to be able to recognize and manage such a device if they were to come across one preoperatively.