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Multicenter Study
. 2012 Apr;33(7):889-94.
doi: 10.1093/eurheartj/ehr298. Epub 2011 Aug 19.

Transvenous phrenic nerve stimulation for the treatment of central sleep apnoea in heart failure

Piotr Ponikowski  1 , Shahrokh Javaheri, Dariusz Michalkiewicz, Bradley A Bart, Danuta Czarnecka, Marek Jastrzebski, Aleksander Kusiak, Ralph Augostini, Dariusz Jagielski, Tomasz Witkowski, Rami N Khayat, Olaf Oldenburg, Klaus-Jürgen Gutleben, Thomas Bitter, Rehan Karim, Conn Iber, Ayesha Hasan, Karl Hibler, Robin Germany, William T Abraham
Affiliations
Multicenter Study

Transvenous phrenic nerve stimulation for the treatment of central sleep apnoea in heart failure

Piotr Ponikowski et al. Eur Heart J. 2012 Apr.

Abstract

Aims: Periodic breathing with central sleep apnoea (CSA) is common in heart failure patients and is associated with poor quality of life and increased risk of morbidity and mortality. We conducted a prospective, non-randomized, acute study to determine the feasibility of using unilateral transvenous phrenic nerve stimulation for the treatment of CSA in heart failure patients.

Methods and results: Thirty-one patients from six centres underwent attempted transvenous lead placement. Of these, 16 qualified to undergo two successive nights of polysomnography-one night with and one night without phrenic nerve stimulation. Comparisons were made between the two nights using the following indices: apnoea-hypopnoea index (AHI), central apnoea index (CAI), obstructive apnoea index (OAI), hypopnoea index, arousal index, and 4% oxygen desaturation index (ODI4%). Patients underwent phrenic nerve stimulation from either the right brachiocephalic vein (n = 8) or the left brachiocephalic or pericardiophrenic vein (n = 8). Therapy period was (mean ± SD) 251 ± 71 min. Stimulation resulted in significant improvement in the AHI [median (inter-quartile range); 45 (39-59) vs. 23 (12-27) events/h, P = 0.002], CAI [27 (11-38) vs. 1 (0-5) events/h, P≤ 0.001], arousal index [32 (20-42) vs. 12 (9-27) events/h, P = 0.001], and ODI4% [31 (22-36) vs. 14 (7-20) events/h, P = 0.002]. No significant changes occurred in the OAI or hypopnoea index. Two adverse events occurred (lead thrombus and episode of ventricular tachycardia), though neither was directly related to phrenic nerve stimulation therapy.

Conclusion: Unilateral transvenous phrenic nerve stimulation significantly reduces episodes of CSA and restores a more natural breathing pattern in patients with heart failure. This approach may represent a novel therapy for CSA and warrants further study.

Trial registration: ClinicalTrials.gov NCT00909259.

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Figures

Figure 1
Figure 1
Elimination of respiratory instability and improvement in oxygenation during unilateral phrenic nerve stimulation in a heart failure patient with central sleep apnoea.
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