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  4. In a porcine model of implantable pacemakers for pediatric unilateral diaphragm paralysis, the phrenic nerve is the best target
 
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April 5, 2024
Journal Article
Title

In a porcine model of implantable pacemakers for pediatric unilateral diaphragm paralysis, the phrenic nerve is the best target

Abstract
Background:
A frequent complication of Fontan operations is unilateral diaphragmatic paresis, which leads to hemodynamic deterioration of the Fontan circulation. A potential new therapeutic option is the unilateral diaphragmatic pacemaker. In this study, we investigated the most effective stimulation location for a potential fully implantable system in a porcine model.
Methods:
Five pigs (20.8 ± 0.95 kg) underwent implantation of a customized cuff electrode placed around the right phrenic nerve. A bipolar myocardial pacing electrode was sutured adjacent to the motor point and peripherally at the costophrenic angle (peripheral diaphragmatic muscle). The electrodes were stimulated 30 times per minute with a pulse duration of 200 µs and a stimulation time of 300 ms. Current intensity was the only variable changed during the experiment.
Results:
Effective stimulation occurred at 0.26 ± 0.024 mA at the phrenic nerve and 7 ± 1.22 mA at the motor point, a significant difference in amperage (p = 0.005). Even with a maximum stimulation of 10 mA at the peripheral diaphragm muscle, however, no effective stimulation was observed.
Conclusion:
The phrenic nerve seems to be the best location for direct stimulation by a unilateral thoracic diaphragm pacemaker in terms of the required amperage level in a porcine model.
Author(s)
Kratz, Tobias
University Hospital Bonn
Dauvergne, Jan
University Hospital Bonn
Ruff, Roman  
Fraunhofer-Institut für Biomedizinische Technik IBMT  
Koch, Timo  
Fraunhofer-Institut für Biomedizinische Technik IBMT  
Breuer, Johannes
University Hospital Bonn
Asfour, Boulos
University Hospital Bonn
Herberg, Ulrike
University Hospital Bonn
Bierbach, Benjamin
University Hospital Bonn
Journal
Journal of cardiothoracic surgery  
Open Access
DOI
10.1186/s13019-024-02707-w
Language
English
Fraunhofer-Institut für Biomedizinische Technik IBMT  
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