Vasconcellos Adam P, Huntley Colin T, Schell Amy E, Soose Ryan J, Boon Maurits S
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2019 Aug;129(8):1949-1953. doi: 10.1002/lary.27488. Epub 2018 Nov 15.
OBJECTIVES/HYPOTHESIS: Upper airway stimulation has demonstrated marked improvements in apnea-hypopnea index, oxygen desaturation index, and quality-of-life measures in patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure. Cardiac arrhythmias are common in patients with OSA and can require electrical cardioversion. We describe the first four reported cases of hypoglossal nerve stimulator (HGNS) dysfunction after electrical cardioversion and illustrate our operative approach to device troubleshooting and repair.
Retrospective case series.
A retrospective review of 201 HGNS implantations performed at two academic institutions revealed four cases of HGNS device dysfunction after electrical cardioversion requiring surgical revision. Preoperative and postoperative device performance metrics and electrical cardioversion specifications were retrospectively assessed and compiled for this case series. The senior authors (R.J.S., M.S.B.) detail operative planning and approach for HGNS implantable pulse generator (IPG) replacement.
At least two patients with HGNS device dysfunction had received cardioversion via anterolateral electrode pad placement. Three patients had received multiple shocks. All four patients experienced a change in device functionality or complete cessation of functionality after electrocardioversion. Operatively, each patient required replacement of the IPG, with subsequent intraoperative interrogation revealing proper device functionality.
Counseling for patients with HGNS undergoing external electrical cardioversion should include possible device damage and need for operative replacement. Anteroposterior electrode pad placement should be considered for patients with HGNS who require electrocardioversion. Operative replacement of an HGNS system damaged by electrocardioversion begins with IPG replacement and intraoperative device interrogation.
4 Laryngoscope, 129:1949-1953, 2019.
目的/假设：对于无法耐受持续气道正压通气的中重度阻塞性睡眠呼吸暂停（OSA）患者，上气道刺激已显示出在呼吸暂停低通气指数、氧饱和度下降指数和生活质量指标方面有显著改善。心律失常在OSA患者中很常见，可能需要电复律。我们描述了首例报道的4例电复律后舌下神经刺激器（HGNS）功能障碍病例，并阐述了我们对该设备故障排查和修复的手术方法。
回顾性病例系列研究。
对在两家学术机构进行的201例HGNS植入手术进行回顾性分析，发现4例电复律后HGNS设备功能障碍需要手术修复。对该病例系列回顾性评估并汇总术前和术后设备性能指标以及电复律规范。资深作者（R.J.S.，M.S.B.）详细介绍了HGNS植入式脉冲发生器（IPG）更换的手术规划和方法。
至少2例HGNS设备功能障碍患者通过前外侧电极片放置进行了电复律。3例患者接受了多次电击。所有4例患者在电复律后均出现设备功能改变或功能完全停止。手术中，每位患者都需要更换IPG，随后术中问询显示设备功能正常。
对于接受体外电复律的HGNS患者的咨询应包括可能的设备损坏以及手术更换的必要性。对于需要电复律的HGNS患者，应考虑前后电极片放置。因电复律受损的HGNS系统的手术更换首先是更换IPG并进行术中设备问询。
4 喉镜，129:1949 - 1953，2019年。
