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

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 phren...

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Published in:	European heart journal Vol. 33; no. 7; pp. 889 - 894
Main Authors:	PONIKOWSKI, Piotr, JAVAHERI, Shahrokh, KHAYAT, Rami N, OLDENBURG, Olaf, GUTLEBEN, Klaus-Jürgen, BITTER, Thomas, KARIM, Rehan, IBER, Conn, HASAN, Ayesha, HIBTER, Karl, GERMANY, Robin, ABRAHAM, William T, MICHALKIEWICZ, Dariusz, BART, Bradley A, CZARNECKA, Danuta, JASTRZEBSKI, Marek, KUSIAK, Aleksander, AUGOSTINI, Ralph, JAGIELSKI, Dariusz, WITKOWSKI, Tomasz
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-04-2012
Subjects:	Aged Apnea Arousal Arousal - physiology Biological and medical sciences Cardiology. Vascular system Clinical Research Electric Stimulation Therapy - methods Feasibility Studies Female Heart Heart diseases Heart Failure - complications Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Lead Male Medical sciences Middle Aged Morbidity Mortality Oxygen Oxygen - blood Phrenic Nerve Pneumology Polysomnography Prospective Studies Quality of life Respiration Respiratory system : syndromes and miscellaneous diseases Sleep Sleep Apnea, Obstructive - complications Sleep Apnea, Obstructive - therapy Sleep disorders Tachycardia Thrombosis Treatment Outcome Veins Heart failure Nervous system diseases Sleep apnea syndrome Respiratory disease Cardiovascular disease Stimulation Treatment Phrenic nerve Phrenic nerve stimulation Heart disease Central sleep apnoea Circulatory system Cardiology
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Summary:	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. 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. 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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-3 ObjectType-Undefined-2
ISSN:	0195-668X 1522-9645
DOI:	10.1093/eurheartj/ehr298