如何植入膈神经刺激器治疗中枢性睡眠呼吸暂停？
How to implant a phrenic nerve stimulator for treatment of central sleep apnea?
机构信息
The Ohio State University Wexner Medical Center, Columbus, Ohio.
Advocate Heart Institute, Chicago, Illinois.
出版信息
J Cardiovasc Electrophysiol. 2019 May;30(5):792-799. doi: 10.1111/jce.13898. Epub 2019 Mar 18.
BACKGROUND
Central sleep apnea (CSA) is a breathing disorder caused by the intermittent absence of central respiratory drive. Transvenous phrenic nerve stimulation is a new therapeutic option, recently approved by the FDA , for the treatment of CSA.
OBJECTIVE
To describe the technique used to implant the transvenous phrenic nerve stimulation system (the remedē System, Respicardia, Inc).
METHODS
The remedē System is placed in the pectoral region, typically on the right side. A single stimulation lead is placed in either the left pericardiophrenic vein (PPV) or the right brachiocephalic vein (RBC). A sensing lead is placed into the azygous vein to detect respiration.
RESULTS
In the remedē System Pivotal trial, 147 of 151 (97%) patients were successfully implanted with the system. Sixty-two percent of stimulation leads were placed in the PPV and 35% in the RBC. Mean procedure time was 2.7 ± 0.8 hours and 94% of patients were free from implant-related serious adverse events through 6 months.
CONCLUSION
In patients with CSA, transvenous phrenic nerve stimulation is an effective and safe therapy with an implant procedure similar to that of cardiac implantable electronic devices.
背景
中枢性睡眠呼吸暂停（CSA）是一种由中枢性呼吸驱动间歇性缺失引起的呼吸障碍。经静脉膈神经刺激是一种新的治疗选择，最近已获得 FDA 批准，用于治疗 CSA。
目的
描述植入经静脉膈神经刺激系统（remedē 系统，Respicardia，Inc.）的技术。
方法
remedē 系统放置在胸区，通常在右侧。单个刺激导联放置在左侧心周肺静脉（PPV）或右侧头臂静脉（RBC）中。感应导联放置在奇静脉中以检测呼吸。
结果
在 remedē 系统关键试验中，151 例患者中有 147 例（97%）成功植入了该系统。62%的刺激导联放置在 PPV 中，35%放置在 RBC 中。平均手术时间为 2.7±0.8 小时，94%的患者在 6 个月内无与植入相关的严重不良事件。
结论
在 CSA 患者中，经静脉膈神经刺激是一种有效且安全的治疗方法，其植入程序与心脏植入式电子设备相似。
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