BACKGROUND: Phrenic nerve stimulation (PNS) complicates the positioning of the left ventricle lead. We present a step-by-step approach to correct PNS during implantation, as established in our daily routine. METHODS: The incidence of PNS, its successful correction, and long-term results (median 27 months) were analyzed retrospectively in 266 lead positions. RESULTS: Phrenic nerve stimulation occurred in 13.9% of the lead positions. Multivariate analysis (P<0.02) showed that PNS only depended on the place of stimulation (coronary sinus side branch). Lead type, CRT indication, and patient's sex had no significant correlation. Following the step-by-step approach presented here, PNS was corrected satisfactorily in all cases. CONCLUSIONS: Approach in case of PNS: 1. push or pull the lead within the same vein, 2. change to a different vein, 3. maintain position in case of a safe distance between the phrenic nerve and the pacing threshold, 4. change the lead type to achieve stable anchorage at adequate positions, 5. use a device featuring electronic repositioning.
BACKGROUND: Phrenic nerve stimulation (PNS) complicates the positioning of the left ventricle lead. We present a step-by-step approach to correct PNS during implantation, as established in our daily routine. METHODS: The incidence of PNS, its successful correction, and long-term results (median 27 months) were analyzed retrospectively in 266 lead positions. RESULTS: Phrenic nerve stimulation occurred in 13.9% of the lead positions. Multivariate analysis (P<0.02) showed that PNS only depended on the place of stimulation (coronary sinus side branch). Lead type, CRT indication, and patient's sex had no significant correlation. Following the step-by-step approach presented here, PNS was corrected satisfactorily in all cases. CONCLUSIONS: Approach in case of PNS: 1. push or pull the lead within the same vein, 2. change to a different vein, 3. maintain position in case of a safe distance between the phrenic nerve and the pacing threshold, 4. change the lead type to achieve stable anchorage at adequate positions, 5. use a device featuring electronic repositioning.
Authors: Andi Eie Albertsen; Jens Cosedis Nielsen; Anders Kirstein Pedersen; Peter Steen Hansen; Henrik Kjaerulf Jensen; Peter Thomas Mortensen Journal: Pacing Clin Electrophysiol Date: 2005-06 Impact factor: 1.976
Authors: Ross T Murphy; Gardar Sigurdsson; Sumanth Mulamalla; Deborah Agler; Zoran B Popovic; Randall C Starling; Bruce L Wilkoff; James D Thomas; Richard A Grimm Journal: Am J Cardiol Date: 2006-04-07 Impact factor: 2.778
Authors: Marmar Vaseghi; David A Cesario; Sen Ji; Kevin M Shannon; Isaac Wiener; Noel G Boyle; Gregg C Fonarow; Miguel Valderrábano; Kalyanam Shivkumar Journal: Pacing Clin Electrophysiol Date: 2005-03 Impact factor: 1.976
Authors: Sue Ellery; Vince Paul; Guenther Prenner; Karlheinz Tscheliessnigg; Bela Merkely; Klaus Malinowski; Gerd Fröhlig; Florian Hintringer; Olaf Bosse; Paolo Diotallevi; Antonio P Ravazzi; Horst Flathmann; Dejan Danilovic; Christina Unterberg-Buchwald Journal: Pacing Clin Electrophysiol Date: 2005-01 Impact factor: 1.976