Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Implantation D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-096 - An Alternative Approach To Phrenic Nerve Stimulation For Central Sleep Apnea (ID 434)


Background: Phrenic nerve stimulation via an implanted device is an alternative to traditional mask-based positive airway pressure therapy for central sleep apnea (CSA). Implant procedures can be challenging for patients with certain vascular anatomies.
Objective: Develop an alternative method to pace the right phrenic nerve for treatment of CSA
Methods: Four patients underwent attempted transvenous passive fixation lead placement, first in the left pericardiophrenic vein and then the right brachiocephalic vein; each experienced vascular incompatibility and subsequent lead dislodgement. Placement of an active fixation lead in the superior vena cava (SVC) adjacent to the right phrenic nerve was attempted. In 3 patients, electroanatomic mapping was used to guide placement of the lead, in 1 patient the lead was placed primarily via fluoroscopy. Contrast was injected after lead placement confirming that perforation of the SVC had not occurred. Phrenic nerve capture was assessed by stimulation threshold and confirmed via palpation of the diaphragm.
Results: Active fixation lead placement was successful in all 4 patients. The average procedure time was 211.3 +/- 20.8 minutes and the average fluoroscopy time was 26.7 +/- 5.9 minutes. The average pacing threshold was 4.6 +/- 2.1 mAmp. All 4 patients were reassessed 1 month later and confirmed to have stable leads where initially placed, have intact lead function, and were initiated on phrenic nerve stimulation therapy.
Conclusion: Active fixation lead placement in the SVC region may be an alternative to passive fixation leads for phrenic nerve stimulation for treatment of CSA for patients with challenging vascular anatomies.