How to implant a phrenic nerve stimulator for treatment of central sleep apnea?

Ralph S. Augostini, Muhammad R. Afzal, Maria Rosa Costanzo, Randy Westlund, Christoph Stellbrink, Klaus Gutleben, Sanjaya Gupta, Moeen Saleem, Timothy W. Smith, Michael Peterson, Michael Drucker, Andrew Merliss, John Hayes, Christen Butter, Matthew Hutchinson, Dariusz Jagielski

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Central sleep apnea (CSA) is a breathing disorder caused by the intermittent absence of central respiratory drive. Transvenous phrenic nerve stimulation is a new therapeutic option, recently approved by the FDA, for the treatment of CSA. Objective: To describe the technique used to implant the transvenous phrenic nerve stimulation system (the remedē System, Respicardia, Inc). Methods: The remedē System is placed in the pectoral region, typically on the right side. A single stimulation lead is placed in either the left pericardiophrenic vein (PPV) or the right brachiocephalic vein (RBC). A sensing lead is placed into the azygous vein to detect respiration. Results: In the remedē System Pivotal trial, 147 of 151 (97%) patients were successfully implanted with the system. Sixty-two percent of stimulation leads were placed in the PPV and 35% in the RBC. Mean procedure time was 2.7 ± 0.8 hours and 94% of patients were free from implant-related serious adverse events through 6 months. Conclusion: In patients with CSA, transvenous phrenic nerve stimulation is an effective and safe therapy with an implant procedure similar to that of cardiac implantable electronic devices.

Original languageEnglish
Pages (from-to)792-799
Number of pages8
JournalJournal of cardiovascular electrophysiology
Issue number5
StatePublished - May 2019


  • central sleep apnea
  • phrenic nerve
  • phrenic nerve stimulation
  • transvenous stimulation


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