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Heart on a string: a novel approach to managing difficult access to the left pericardiacophrenic vein for phrenic nerve stimulation

Wenn das Herz am seidenen Faden hängt – ein neuer Ansatz für den schwierigen Zugang zur linken V. pericardiacophrenica im Rahmen der Implantation eines Zwerchfellschrittmachers

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Abstract

This case highlights the difficulties in pacing lead implantation for transvenous phrenic nerve stimulation to treat central sleep apnea in heart failure. Cannulation of the left pericardiacophrenic vein (PPV) initially failed due to vessel tortuosity. On the basis of sound knowledge of collateral vessels, the inferior phrenic vein (IPV), which drains into the inferior vena cava, was intubated using a guide catheter. A guidewire could be retrogradely advanced via the IPV to the left PPV and brachiocephalic vein. The wire was captured via a snare catheter, such that the heart was held “on a string”, thereby providing adequate support for lead placement.

Zusammenfassung

Dieser Fallbericht schildert Herausforderungen bei der Implantation der Stimulationselektrode von Zwerchfellschrittmachern zur Behandlung der zentralen Schlafapnoe bei Herzinsuffizienz. Nach zunächst erfolglosen Intubationsversuchen an der linken V. pericardiacophrenica wurde die in die V. cava inferior drainierende V. phrenica inferior mit einem Führungskatheter intubiert und ein Führungsdraht hierüber retrograd durch die V. pericardiacophrenica in die V. brachiocephalica eingeführt. Der Draht wurde über einen Snare-Katheter gefangen und bot genug Stabilität für die letztendlich erfolgreiche Implantation der Elektrode.

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Authors and Affiliations

  1. Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bielefeld Mitte, Teutoburger Straße 50, 33604, Bielefeld, Germany

    Dennis Lawin,  Bert Hansky,  Philipp Baumann &  Christoph Stellbrink

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  1. Dennis Lawin
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  2. Bert Hansky
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  3. Philipp Baumann
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  4. Christoph Stellbrink
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Correspondence to Christoph Stellbrink.

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Conflict of interest

C. Stellbrink received honoraria from Respicardia, Inc., Minnetonka, Minnesota, USA. D. D. Lawin, B. Hansky, and P. Baumann declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians.

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Lawin, D., Hansky, B., Baumann, P. et al. Heart on a string: a novel approach to managing difficult access to the left pericardiacophrenic vein for phrenic nerve stimulation. Herzschr Elektrophys 29, 322–324 (2018). https://doi.org/10.1007/s00399-018-0587-6

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  • DOI: https://doi.org/10.1007/s00399-018-0587-6

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