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

  • Sleep Breathing Physiology and Disorders • Original Article
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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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Author notes

  1. Klaus-Jürgen Gutleben and Henrik Fox contributed equally to this work.

Authors and Affiliations

  1. Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany

    Klaus-Jürgen Gutleben, Philipp Sommer & Georg Nölker

  2. Medizinische Klinik III/Kardiologie, Klinikum Herford, Herford, Germany

    Klaus-Jürgen Gutleben

  3. Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany

    Henrik Fox & Volker Rudolph

  4. Innere Klinik II, Kardiologie, Katharinen-Hospital Unna, Unna, Germany

    Georg Nölker

Authors
  1. Klaus-Jürgen Gutleben
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  2. Henrik Fox
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  3. Philipp Sommer
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  4. Volker Rudolph
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  5. Georg Nölker
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Corresponding author

Correspondence to Henrik Fox.

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Conflict of interest

Klaus-Jürgen Gutleben has received honoraria for lectures and proctoring from Respicardia Inc., Minnetonka, MN, USA. All the other authors have no conflict of interest to declare regarding the content of this study.

Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animals are involved in this research.

Informed consent

This retrospective analysis of implantation procedures involves data exploration of humans that had the remede system implanted and gave their written informed consent. In addition to that, approval for conducting this study was obtained by our local ethics committee beforehand.

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Gutleben, KJ., Fox, H., Sommer, P. et al. Interventional techniques to increase implantation success of transvenous phrenic nerve stimulation for central sleep apnea treatment. Sleep Breath 24, 905–912 (2020). https://doi.org/10.1007/s11325-019-01917-0

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  • DOI: https://doi.org/10.1007/s11325-019-01917-0

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