Zusammenfassung
Hintergrund
Die Stimulation des N. phrenicus (NPS) erschwert die ideale Positionierung der linksventrikulären (LV)-Elektrode. Wir stellen ein klinisch etabliertes Stufenschema zur Behebung der NPS während der Implantation vor.
Studiendesign und Untersuchungsmethoden
Die Inzidenz einer NPS, Korrekturmöglichkeiten und Spätergebnisse (Median 27 Monate) wurden in einer retrospektiven Analyse von 266 LV-Elektroden-Positionen ausgewertet.
Ergebnisse
13,9% der Elektrodenpositionen zeigten intraoperativ eine NPS. In multivariater (p<0,02) Analyse korrelierte die Häufigkeit der NPS mit dem Stimulationsort (Koronarsinusseitenast). Indikation zur kardialen Resynchronisation, Elektrodentyp und Patientengeschlecht zeigten keine Signifikanz.
Anhand des angegebenen Stufenschemas ließ sich die NPS in allen Fällen zufrieden stellend beheben.
Schlussfolgerung
Bei intraoperativ auftretender NPS sollte wie folgt vorgegangen werden: 1. Vor- oder Zurückschieben der Elektrode in derselben Vene, 2. Umpositionieren in andere Vene, 3. bei sicherem Abstand zwischen Phrenikus- und Pacing-Reizschwelle Belassen der Position, 4. Umstieg auf anderen Elektrodentyp zur stabilen Verankerung an geeigneter Position, 5. primäre Verwendung oder Umstieg auf Aggregat mit „electronic repositioning“.
Abstract
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 in13.9% 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.
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Schwierz, T., Winter, S., Pürerfellner, H. et al. N.-phrenicus-Stimulation bei biventrikulären Schrittmachern. Chirurg 78, 1037–1040 (2007). https://doi.org/10.1007/s00104-007-1368-7
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DOI: https://doi.org/10.1007/s00104-007-1368-7