TY - JOUR
T1 - Transvenous phrenic nerve stimulation for the treatment of central sleep apnoea in heart failure
AU - Ponikowski, Piotr
AU - Javaheri, Shahrokh
AU - Michalkiewicz, Dariusz
AU - Bart, Bradley A
AU - Czarnecka, Danuta
AU - Jastrzebski, Marek
AU - Kusiak, Aleksander
AU - Augostini, Ralph
AU - Jagielski, Dariusz
AU - Witkowski, Tomasz
AU - Khayat, Rami N.
AU - Oldenburg, Olaf
AU - Gutleben, Klaus Jürgen
AU - Bitter, Thomas
AU - Karim, Rehan
AU - Iber, Conn
AU - Hasan, Ayesha
AU - Hibler, Karl
AU - Germany, Robin
AU - Abraham, William T.
N1 - Funding Information:
This study was supported by Respicardia, Inc., Minnetonka, MN, USA.
PY - 2012/4
Y1 - 2012/4
N2 - 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. ClinicalTrials.gov identifier: NCT00909259. Published on behalf of the European Society of Cardiology. All rights reserved.
AB - 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. ClinicalTrials.gov identifier: NCT00909259. Published on behalf of the European Society of Cardiology. All rights reserved.
KW - Central sleep apnoea
KW - Heart failure
KW - Phrenic nerve stimulation
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U2 - 10.1093/eurheartj/ehr298
DO - 10.1093/eurheartj/ehr298
M3 - Article
C2 - 21856678
AN - SCOPUS:84859494480
SN - 0195-668X
VL - 33
SP - 889
EP - 894
JO - European heart journal
JF - European heart journal
IS - 7
ER -