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Sleep and Breathing

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01-09-2020 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

Interventional techniques to increase implantation success of transvenous phrenic nerve stimulation for central sleep apnea treatment

Authors: Klaus-Jürgen Gutleben, Henrik Fox, Philipp Sommer, Volker Rudolph, Georg Nölker

Published in: Sleep and Breathing | Issue 3/2020

Abstract

Purpose

Central sleep apnea (CSA) is a highly common comorbidity in heart failure (HF) patients and is known to deteriorate quality of life and prognosis. Effective treatment options are scarce. Transvenous phrenic nerve stimulation (PNS) has been shown to be effective and safe in CSA treatment in HF. However, lead implantation may be difficult or fail due to anatomical or technical challenges. We report novel and innovative approaches applying different interventional techniques to enhance PNS implantation success, allowing otherwise missing CSA treatment.

Methods

Twenty-seven consecutive HF patients (86% male, mean age: 69 ± 11 years; reduced left ventricular ejection fraction in 16 patients (57%)) were included in this study who were unable to tolerate or had contraindications for mask-based therapy. We evaluated PNS total implantation success, procedural characteristics, and feasibility and success rates of intravascular interventions to facilitate PNS lead implantation in otherwise ineffective procedures.

Results

Seven lead implantation attempts (24%) required additional intravascular interventional action to facilitate successful implantation, mainly consisting of balloon angioplasties to allow optimal PNS lead placement. Two procedures remained unsuccessful and two patients underwent a second procedure due to stimulation side effects and lead fracture respectively. All over, no complications resulted from application of interventional techniques to achieve a 93% implantation success rate.

Conclusion

Transvenous PNS lead placement for CSA treatment can be difficult and challenging. However, interventional intravascular techniques markedly increase implantation success and thereby allow application of this therapy for effective CSA treatment in most patients without additional complications.

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Title: Interventional techniques to increase implantation success of transvenous phrenic nerve stimulation for central sleep apnea treatment
Authors: Klaus-Jürgen Gutleben
Henrik Fox
Philipp Sommer
Volker Rudolph
Georg Nölker
Publication date: 01-09-2020
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Heart Failure
Nerve Stimulation
Cardiac Resynchronization Therapy
Phlebography
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Published in: Sleep and Breathing / Issue 3/2020
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-019-01917-0

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