Xi-Long Zhang1, Ning Ding1, Hong Wang2, Ralph Augostini3, Bing Yang4, Di Xu4, Weizhu Ju4, Xiaofeng Hou4, Xinli Li4, Buqing Ni5, Kejiang Cao4, Isaac George6, Jie Wang7, Shi-Jiang Zhang8. 1. Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 2. Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Surgery, and Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. 3. Department of Cardiology, Medical School, Ohio State University, Columbus, OH. 4. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 5. Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 6. Division of Cardiothoracic Surgery, Columbia University, New York, NY. 7. Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 8. Department of Respirology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: shijiangzhang@hotmail.com.
Abstract
BACKGROUND: Cheyne-Stokes respiration (CSR), which often occurs in patients with congestive heart failure (CHF), may be a predictor for poor outcome. Phrenic nerve stimulation (PNS) may interrupt CSR in patients with CHF. We report the clinical use of transvenous PNS in patients with CHF and CSR. METHODS: Nineteen patients with CHF and CSR were enrolled. A single stimulation lead was placed at the junction between the superior vena cava and brachiocephalic vein or in the left-side pericardiophrenic vein. PNS stimulation was performed using Eupnea System device (RespiCardia Inc). Respiratory properties were assessed before and during PNS. PNS was assessed at a maximum of 10 mA. RESULTS: Successful stimulation capture was achieved in 16 patients. Failure to capture occurred in three patients because of dislocation of leads. No adverse events were seen under maximum normal stimulation parameters for an overnight study. When PNS was applied following a series of central sleep apneic events, a trend toward stabilization of breathing and heart rate as well as improvement in oxygen saturation was seen. Compared with pre-PNS, during PNS there was a significant decrease in apnea-hypopnea index (33.8 ± 9.3 vs 8.1 ± 2.3, P = .00), an increase in mean and minimal oxygen saturation as measured by pulse oximetry (89.7% ± 1.6% vs 94.3% ± 0.9% and 80.3% ± 3.7% vs 88.5% ± 3.3%, respectively, all P = .00) and end-tidal CO2 (38.0 ± 4.3 mm Hg vs 40.3 ± 3.1 mm Hg, P = .02), but no significant difference in sleep efficiency (74.6% ± 4.1% vs 73.7% ± 5.4%, P = .36). CONCLUSIONS: The preliminary results showed that in a small group of patients with CHF and CSR, 1 night of unilateral transvenous PNS improved indices of CSR and was not associated with adverse events.
BACKGROUND: Cheyne-Stokes respiration (CSR), which often occurs in patients with congestive heart failure (CHF), may be a predictor for poor outcome. Phrenic nerve stimulation (PNS) may interrupt CSR in patients with CHF. We report the clinical use of transvenous PNS in patients with CHF and CSR. METHODS: Nineteen patients with CHF and CSR were enrolled. A single stimulation lead was placed at the junction between the superior vena cava and brachiocephalic vein or in the left-side pericardiophrenic vein. PNS stimulation was performed using Eupnea System device (RespiCardia Inc). Respiratory properties were assessed before and during PNS. PNS was assessed at a maximum of 10 mA. RESULTS: Successful stimulation capture was achieved in 16 patients. Failure to capture occurred in three patients because of dislocation of leads. No adverse events were seen under maximum normal stimulation parameters for an overnight study. When PNS was applied following a series of central sleep apneic events, a trend toward stabilization of breathing and heart rate as well as improvement in oxygen saturation was seen. Compared with pre-PNS, during PNS there was a significant decrease in apnea-hypopnea index (33.8 ± 9.3 vs 8.1 ± 2.3, P = .00), an increase in mean and minimal oxygen saturation as measured by pulse oximetry (89.7% ± 1.6% vs 94.3% ± 0.9% and 80.3% ± 3.7% vs 88.5% ± 3.3%, respectively, all P = .00) and end-tidal CO2 (38.0 ± 4.3 mm Hg vs 40.3 ± 3.1 mm Hg, P = .02), but no significant difference in sleep efficiency (74.6% ± 4.1% vs 73.7% ± 5.4%, P = .36). CONCLUSIONS: The preliminary results showed that in a small group of patients with CHF and CSR, 1 night of unilateral transvenous PNS improved indices of CSR and was not associated with adverse events.
Authors: Marat Fudim; Andrew R Spector; Maria-Rosa Costanzo; Sean D Pokorney; Robert J Mentz; Dariusz Jagielski; Ralph Augostini; William T Abraham; Piotr P Ponikowski; Scott W McKane; Jonathan P Piccini Journal: J Clin Sleep Med Date: 2019-11-05 Impact factor: 4.062
Authors: Ralph S Augostini; Muhammad R Afzal; Maria Rosa Costanzo; Randy Westlund; Christoph Stellbrink; Klaus Gutleben; Sanjaya Gupta; Moeen Saleem; Timothy W Smith; Michael Peterson; Michael Drucker; Andrew Merliss; John Hayes; Christen Butter; Matthew Hutchinson; Dariusz Jagielski Journal: J Cardiovasc Electrophysiol Date: 2019-03-18