Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Medizinische Klinik III/Kardiologie, Klinikum Herford, Herford, Germany.
Sleep Breath. 2020 Sep;24(3):905-912. doi: 10.1007/s11325-019-01917-0. Epub 2019 Aug 12.
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.
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.
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.
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.
中枢性睡眠呼吸暂停（CSA）是心力衰竭（HF）患者中一种非常常见的合并症，已知会降低生活质量和预后。有效的治疗选择很少。经静脉膈神经刺激（PNS）已被证明在 HF 中 CSA 治疗中是有效和安全的。然而，由于解剖或技术挑战，可能会出现置管困难或失败。我们报告了应用不同介入技术的新的创新方法，以提高 PNS 植入的成功率，从而使原本无法治疗 CSA 的患者得到治疗。
本研究纳入了 27 例连续的 HF 患者（86%为男性，平均年龄：69±11 岁；16 例患者左心室射血分数降低（57%）），这些患者无法耐受或存在面罩治疗的禁忌证。我们评估了 PNS 总植入成功率、手术特点、以及血管内介入以促进 PNS 导丝植入的可行性和成功率，从而提高在原本无效的手术中 PNS 导丝植入的成功率。
7 次（24%）导丝植入尝试需要额外的血管内介入操作来促进成功植入，主要包括球囊血管成形术，以允许最佳的 PNS 导丝放置。有 2 个手术仍然不成功，2 个患者分别由于刺激副作用和导丝断裂而进行了第二次手术。总的来说，应用介入技术以实现 93%的植入成功率并没有导致并发症。
CSA 治疗的经静脉 PNS 导丝放置可能困难且具有挑战性。然而，血管内介入技术可显著提高植入成功率，从而使该治疗方法可有效地应用于大多数患者，而不会增加额外的并发症。
