General thoracic surgery
Intrathoracic phrenic pacing: A 10-year experience in France

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Background

Phrenic pacing is an alternative to positive-pressure ventilation in selected patients, mostly in cases of upper spinal cord injury. We evaluated results of phrenic pacing performed by video-assisted thoracic surgery (VATS).

Method

Between 1997 and 2007, after complete neuromuscular investigations, 20 patients requiring full-time ventilation were selected for phrenic pacing (19 with posttraumatic tetraplegia and 1 with congenital central hypoventilation syndrome). Quadripolar cuff electrodes were fixed around each intrathoracic phrenic nerve via bilateral VATS. They were connected to a subcutaneous radiofrequency receiver coupled to an external radiofrequency transmitter. All patients participated in a reconditioning program beginning 2 weeks after implantation and continued until ventilatory weaning.

Results

Phrenic pacing was successful in all cases. No intraoperative complications or perioperative mortality were observed. Intraoperative testing detected stimulation thresholds in 19 patients (range, 0.05-2.9 mA). Ventilatory weaning was obtained in 18 patients. Median diaphragm reconditioning time was 6 weeks (2 weeks–11 months). Reconditioning was still in process in a young woman and was not achieved in an elderly woman with a 4-year history of tetraplegia. All the patients weaned from mechanical ventilation reported improved quality of life. Failure or delay in recovery of effective diaphragm contraction was due to nonreversible amyotrophy.

Conclusions

VATS implantation of 4-pole electrodes around the intrathoracic phrenic nerve is a safe procedure. Ventilatory weaning correlates with the degree of diaphragmatic amyotrophy. Phrenic pacing, performed as soon as neurologic and orthopedic stabilization is achieved, is the most important prognostic factor for successful weaning.

CTSNet classification

6

Abbreviations and Acronyms

EMG
electromyographic
VATS
video-assisted thoracic surgery

Cited by (0)

The study was supported by grant DRC98075 from the Programme Hospitalier de Recherche Clinique National of the French Ministry of Heatlh (PHRC) and by association ADOREP, Paris, France. The diaphragm pacing activity of the Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France, is supported in part by association ADEP, Puteaux, France and by association CARDIF, Fontenay-aux-Roses, France.

Disclosures: T. Similowski received honoraria from Atrotech Ltd for the translation from English to French of the user’s manual of the Atrostim device used in the patients described in this article, in 2002. There are no other conflicts of interest involved.