Key result
Phrenic nerve stimulation occurred in 12.9% of patients and was significantly more frequent at middle-lateral/posterior and apical LV sites compared to other sites (13.8% vs 6.7%; P=0.01).
Why the study?
Does left ventricular lead type and placement site affect the risk of phrenic nerve stimulation in patients undergoing cardiac resynchronization therapy?
Cohort (n=1,307)
Yes
Does left ventricular lead type and placement site affect the risk of phrenic nerve stimulation in patients undergoing cardiac resynchronization therapy?
Phrenic nerve stimulation occurs in approximately 13% of CRT patients and is significantly more common with lateral and apical LV lead placements, though most cases can be managed with electrical reprogramming.
Answers are grounded in this paper and cite their sources.
Site-specific LV lead placement may influence phrenic nerve stimulation risk in CRT; leaves open optimal positioning strategies pending prospective trials.
AIMS: Unwanted phrenic nerve stimulation (PNS) has been reported in ∼1 in 4 patients undergoing left ventricular (LV) pacing. The occurrence of PNS over mid-term follow-up and the significance of PNS are less certain. METHODS AND RESULTS: Data from 1307 patients enrolled in pre-market studies of LV leads manufactured by Medtronic (models 4193 and 4195 unipolar, 4194, 4196, 4296, and 4396 bipolar) were pooled. Left ventricular lead location was recorded at implant using a common classification scheme. Phrenic nerve stimulation symptoms were either spontaneously reported or identified at scheduled follow-up visits. A PNS-related complication was defined as PNS resulting in invasive intervention or the termination of LV pacing. Average follow-up was 14.9 months (range 0.0-46.6). Phrenic nerve stimulation symptoms occurred in 169 patients (12.9%). Phrenic nerve stimulation-related complications occurred in 21 of 1307 patients (1.6%); 16 of 738 (2.2%) in the unipolar lead studies, and 5 of 569 (0.9%) in the bipolar lead studies (P = 0.08). Phrenic nerve stimulation was more frequent at middle-lateral/posterior, and apical LV sites (139/1010) vs. basal-posterior/lateral/anterior, and middle-anterior sites (20/297; P= 0.01). As compared with an anterior LV lead position, a lateral LV pacing site was associated with over a four-fold higher risk of PNS (P= 0.005) and an apical LV pacing site was associated with over six-fold higher risk of PNS (P= 0.001). CONCLUSION: Phrenic nerve stimulation occurred in 13% of patients undergoing LV lead placement and was more common at mid-lateral/posterior, and LV apical sites. Most cases (123/139; 88%) of PNS were mitigated via electrical reprogramming, without the need for invasive intervention.
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Biffi et al. (2012) conducted a cohort in Cardiac resynchronization therapy (n=1,307). Middle-lateral/posterior and apical left ventricular lead placement vs. Basal-posterior/lateral/anterior and middle-anterior left ventricular lead placement was evaluated on Phrenic nerve stimulation symptoms (p=0.01). Phrenic nerve stimulation occurred in 12.9% of patients and was significantly more frequent at middle-lateral/posterior and apical LV sites compared to other sites (13.8% vs 6.7%; P=0.01).
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