Diaphragm pacing by electrical stimulation of the phrenic nerve - PubMed

Review

Diaphragm pacing by electrical stimulation of the phrenic nerve

W W Glenn et al. Neurosurgery. 1985 Dec.

Abstract

Sophisticated techniques for electrical stimulation of excitable tissue to treat neuromuscular disorders rationally have been developed over the past 3 decades. A historical review shows that electricity has been applied to the phrenic nerves to activate the diaphragm for some 200 years. Of the contemporary methods for stimulating the phrenic nerve in cases of ventilatory insufficiency, the authors prefer stimulation of the phrenic nerve in the thorax using a platinum ribbon electrode placed behind the nerve and an attached subcutaneously implanted radiofrequency (RF) receiver inductively coupled to an external RF transmitter. Instructions are given for implanting the electrode-receiver assembly, emphasizing atraumatic handling of the phrenic nerve and strict aseptic techniques. Diaphragm pacing is conducted with low frequency electrical stimulation at a slow repetition (respiratory) rate to condition the diaphragm muscle against fatigue and maintain it fatigue-free. Candidates for diaphragm pacing are those with ventilatory insufficiency due to malfunction of the respiratory control center or interruption of the upper motor neurons of the phrenic nerve. In the Yale series, there were 77 patients treated by diaphragm pacing; 63 (82%) started before 1981 and thus were available for follow-up for at least 5 years; 33 (52%) were paced for 5 to 10 years, and 15 (24%) were paced for 10 to 16. Long term stimulation of the phrenic nerves to pace the diaphragm is an effective method of ventilatory support in selected cases.

Similar articles

• Evaluation of phrenic nerve and diaphragm function with peripheral nerve stimulation and M-mode ultrasonography in potential pediatric phrenic nerve or diaphragm pacing candidates.

  Skalsky AJ, Lesser DJ, McDonald CM. Skalsky AJ, et al. Phys Med Rehabil Clin N Am. 2015 Feb;26(1):133-43. doi: 10.1016/j.pmr.2014.09.010. Phys Med Rehabil Clin N Am. 2015. PMID: 25479785 Review.

• The learning curve for investigational surgery: lessons learned from laparoscopic diaphragm pacing for chronic ventilator dependence.

  Onders RP, DiMarco AF, Ignagni AR, Mortimer JT. Onders RP, et al. Surg Endosc. 2005 May;19(5):633-7. doi: 10.1007/s00464-004-8934-6. Epub 2005 Mar 23. Surg Endosc. 2005. PMID: 15776209

• Diaphragm pacing with the spinal cord stimulator.

  Mitsuyama T, Taira T, Takeda N, Hori T. Mitsuyama T, et al. Acta Neurochir Suppl. 2003;87:89-92. doi: 10.1007/978-3-7091-6081-7_19. Acta Neurochir Suppl. 2003. PMID: 14518531 Clinical Trial.

• Mapping the phrenic nerve motor point: the key to a successful laparoscopic diaphragm pacing system in the first human series.

  Onders RP, Dimarco AF, Ignagni AR, Aiyar H, Mortimer JT. Onders RP, et al. Surgery. 2004 Oct;136(4):819-26. doi: 10.1016/j.surg.2004.06.030. Surgery. 2004. PMID: 15467667

• Diaphragmatic pacing in spinal cord injury.

  Dalal K, DiMarco AF. Dalal K, et al. Phys Med Rehabil Clin N Am. 2014 Aug;25(3):619-29, viii. doi: 10.1016/j.pmr.2014.04.004. Epub 2014 Jun 16. Phys Med Rehabil Clin N Am. 2014. PMID: 25064791 Review.

Cited by

• Diaphragm pacing: the state of the art.

  Le Pimpec-Barthes F, Legras A, Arame A, Pricopi C, Boucherie JC, Badia A, Panzini CM. Le Pimpec-Barthes F, et al. J Thorac Dis. 2016 Apr;8(Suppl 4):S376-86. doi: 10.21037/jtd.2016.03.97. J Thorac Dis. 2016. PMID: 27195135 Free PMC article. Review.

• Gerta Vrbová, a guide and a friend for a generation of neuro-myologists - Her scientific legacies and relations with colleagues.

  Carraro U. Carraro U. Eur J Transl Myol. 2021 Mar 26;31(1):9670. doi: 10.4081/ejtm.2021.9670. Eur J Transl Myol. 2021. PMID: 33709645 Free PMC article.

• Phrenic nerve stimulation to prevent diaphragmatic dysfunction and ventilator-induced lung injury.

  Panelli A, Verfuß MA, Dres M, Brochard L, Schaller SJ. Panelli A, et al. Intensive Care Med Exp. 2023 Dec 18;11(1):94. doi: 10.1186/s40635-023-00577-5. Intensive Care Med Exp. 2023. PMID: 38109016 Free PMC article. Review.

• Comparison of wire and disc electrodes to electrically activate the inspiratory muscles in dogs.

  Kowalski KE, DiMarco AF. Kowalski KE, et al. J Neurosci Methods. 2021 Jun 1;357:109176. doi: 10.1016/j.jneumeth.2021.109176. Epub 2021 Apr 2. J Neurosci Methods. 2021. PMID: 33819557 Free PMC article.

• The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury.

  Karamian BA, Siegel N, Nourie B, Serruya MD, Heary RF, Harrop JS, Vaccaro AR. Karamian BA, et al. J Orthop Traumatol. 2022 Jan 6;23(1):2. doi: 10.1186/s10195-021-00623-6. J Orthop Traumatol. 2022. PMID: 34989884 Free PMC article. Review.

Publication types

MeSH terms

LinkOut - more resources

• Full Text Sources

  • Ovid Technologies, Inc.
  • Wolters Kluwer

• Other Literature Sources

  • The Lens - Patent Citations Database

• Miscellaneous

  • NCI CPTAC Assay Portal