Clinical Analysis And Treatment Strategies Of Phrenic Nerve Stimulation During And After Cardiac Resynchronization Therapy

Objective To discuss the treatment of the phrenic nerve stimulation during and after cardiac resynchronization therapy.Methods Clinical data of 42 patients with chronic heart failure who were implanted CRT(cardiac resynchronization therapy) systems in the last three years were retrospectively analyzed.Everyone had already been under the sufficient drug treatment against heart failure,but the evaluation of heart function refer to the NYHA classify still remained levelⅢorⅣ.The result of ultrasonic cardiogram and electrocardiogram were also consistent with the groupⅠindication of＜Suggestions of Cardiac resynchronization therapy to chronic heart failure in china＞.There was a close follow-up visit after intervention,then the achievement ratio,curative effect and complications were analyzed separately.Result 41 of 42 patients were implanted CRT systems successfully,and there were 8 patients encountered phrenic nerve stimulation during the operations.1 of 8 patient was implanted CS electrodes in lateral-marginal vein,and 5 patients' CS electrodes were located in posterolateral veins,compared to posterior veins in the other 2 patients.All these 8 patients were cured by the methods of minimal shift of CS electrode in the target veins,reposition of CS electrode in the other branchs of target veins,or changing another target veins.There were 2 patients suffered from phrenic nerve stimulation after operations.Finally,they were cured by the method of changing pacing configurations or repositing coronary sinus lead.Conclusion CRT,as a new non-drug treatment for chronic heart failure,was safe and effective on the whole,lacking of serious complications.Prevention of phrenic nerve stimulation during the operations was more important relatively,such as by the method of adjustments of CS electrodes' locations during the operations.And we also had some good methods,such as programmable multiple pacing configurations and minimal invasive coronary sinus lead reposition technique to solve this tough problem after the operations.