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Original Research: Sleep Disorders |

Transvenous Phrenic Nerve Stimulation in Patients With Cheyne-Stokes Respiration and Congestive Heart FailurePhrenic Nerve Stimulation in Heart Failure: A Safety and Proof-of-Concept Study

Xi-Long Zhang, MD; Ning Ding, MD; Hong Wang, MD; Ralph Augostini, MD; Bing Yang, MD; Di Xu, MD; Weizhu Ju, MD; Xiaofeng Hou, MD; Xinli Li, MD; Buqing Ni, PhD; Kejiang Cao, MD; Isaac George, MD; Jie Wang, MD, PhD; Shi-Jiang Zhang, MD
Author and Funding Information

From the Department of Respirology (Drs X.-L. Zhang, Ding, and H. Wang), Department of Cardiology (Drs Yang, Xu, Ju, Hou, Li, Cao, and J. Wang), and Department of Cardiothoracic Surgery (Drs S.-J. Zhang and Ni), The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology (Dr Augostini), Medical School, Ohio State University, Columbus, OH; and Division of Cardiothoracic Surgery (Dr George), Department of Surgery, and Division of Cardiology (Dr J. Wang), Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.

Correspondence to: Shi-Jiang Zhang, MD, Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing 210029, China; e-mail: shijiangzhang@hotmail.com


For editorial comment see page 821

Funding/Support: This study was funded by RespiCardia Inc, Minnetonka, MN, through a contract with the First Affiliated Hospital of Nanjing Medical University.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):927-934. doi:10.1378/chest.11-1899
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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.

Trial registry:  ClinicalTrials.gov; No.: NCT00909259; URL: www.clinicaltrials.gov

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