Long-term intramuscular electrical activation of the phrenic nerve: safety and reliability

The safety and reliability of a system for long-term intramuscular electrical activation of the phrenic nerve was evaluated in seven dogs. In this system, electrodes are implanted bilaterally into the diaphragm without directly contacting the phrenic nerve using a laparoscope to direct placement. Five dogs underwent chronic bilateral intramuscular diaphragm stimulation (IDS) for 61 to 183 days at stimulus parameters selected to evoke at least 120% of the animal's basal ventilation. Two dogs maintained as controls did not undergo chronic stimulation. The safety and reliability of the system was evaluated in terms of tissue responses to the electrode, alterations in diaphragm muscle, pulmonary function, electrode reliability, and cardiac activation. No adverse responses to the electrode or stimulation were found. The histochemistry of chronically stimulated diaphragm suggested transformation towards type I (oxidative metabolism) muscle fibers. Two IDS electrodes dislodged out of a total of 32 IDS electrodes implanted. Both electrodes dislodged within seven days of implant. All IDS electrodes had stable and repeatable recruitment properties. No IDS electrode mechanical failures were found and no electrode corrosion was observed. It is concluded from these experiments that intramuscular activation of the phrenic nerve will present a minimal risk to human patients who are good candidates for clinical studies using this technique.<<ETX>>

[1]  K. Krishnan,et al.  MECHANISM OF UNEXPECTED DEATH IN A PATIENT WITH C2 QUADRIPLEGIA VENTILATED BY AID OF A PHRENIC NERVE STIMULATOR: Brief Report , 1992, American journal of physical medicine & rehabilitation.

[2]  J. Mortimer,et al.  Taking the laparoscope to the laboratory for ventilatory research. , 1990, The American surgeon.

[3]  Electrical Activation of Respiratory Muscles by Methods Other than Phrenic Nerve Cuff Electrodes , 1989, Pacing and clinical electrophysiology : PACE.

[4]  J T Mortimer,et al.  Muscle plasticity: comparison of a 30-Hz burst with 10-Hz continuous stimulation. , 1989, Journal of applied physiology.

[5]  H. Fodstad,et al.  Fundamental Considerations in Pacing of the Diaphragm for Chronic Ventilatory Insufficiency: A Multi‐Center Study , 1988, Pacing and clinical electrophysiology : PACE.

[6]  W. Mayr,et al.  The phrenic pacemaker. Substitution of paralyzed functions in tetraplegia. , 1987, ASAIO transactions.

[7]  L. Wetstein Technique for implantation of phrenic nerve electrodes. , 1987, The Annals of thoracic surgery.

[8]  Baer Ga,et al.  International Symposium on Implanted Phrenic Nerve Stimulators for Respiratory Insufficiency. , 1987 .

[9]  M. Reynolds Diaphragmatic pacing in infants: Techniques and results , 1986 .

[10]  W. Glenn,et al.  Twenty Years of Experience in Phrenic Nerve Stimulation to Pace the Diaphragm , 1986, Pacing and clinical electrophysiology : PACE.

[11]  J. T. Mortimer,et al.  Intramuscular Electrical Activation of the Phrenic Nerve , 1986, IEEE Transactions on Biomedical Engineering.

[12]  A. Grassino,et al.  In vivo length and shortening of canine diaphragm with body postural change. , 1986, Journal of applied physiology.

[13]  A. Grassino,et al.  In vivo length-force relationship of canine diaphragm. , 1986, Journal of applied physiology.

[14]  W. Glenn,et al.  Diaphragm Pacing by Electrical Stimulation of the Phrenic Nerve , 1985, Neurosurgery.

[15]  C. Hunt,et al.  Diaphragmatic pacing in infants: techniques and results. , 1985, The Annals of thoracic surgery.

[16]  H. A. Dahl,et al.  The histochemistry of the posterior cricoarytenoid (PCA) muscle in the dog, compared with the diaphragm, the sternothyroid and the sternomastoid muscle. , 1985, Acta oto-laryngologica.

[17]  T. Stellato,et al.  Diaphragm activation with laparoscopically placed intramuscular electrodes in dogs , 1985 .

[18]  J. Mortimer,et al.  Conditioning of the diaphragm with phrenic nerve stimulation after prolonged disuse. , 1984, The American review of respiratory disease.

[19]  William W. L. Glenn,et al.  Ventilatory support by pacing of the conditioned diaphragm in quadriplegia. , 1984, The New England journal of medicine.

[20]  S. Salmons,et al.  The sequential replacement of myosin subunit isoforms during muscle type transformation induced by long term electrical stimulation. , 1983, The Journal of biological chemistry.

[21]  W A Whitelaw,et al.  Relationships among pressure, tension, and shape of the diaphragm. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.

[22]  J T Mortimer,et al.  Diaphragm activation with intramuscular stimulation in dogs. , 1983, The American review of respiratory disease.

[23]  H. Fodstad,et al.  Artificial respiration by phrenic nerve stimulation (diaphragm pacing) in patients with cervical cord and brain stem lesions. , 1983, Scandinavian journal of rehabilitation medicine.

[24]  W. Glenn,et al.  Response of the diaphragm muscle to electrical stimulation of the phrenic nerve. A histochemical and ultrastructural study. , 1983, Journal of neurosurgery.

[25]  E. Manuelidis,et al.  Light and electron microscopic studies of phrenic nerves after long-term electrical stimulation. , 1983, Journal of neurosurgery.

[26]  C. Hunt,et al.  Phrenic nerve pacing in infants and children: a review of experience and report on the usefulness of phrenic nerve stimulation studies. , 1983, The Journal of pediatrics.

[27]  L. Edmunds,et al.  Electrical conditioning of in situ skeletal muscle for replacement of myocardium. , 1982, The Journal of surgical research.

[28]  F P Primiano,et al.  Theoretical analysis of chest wall mechanics. , 1982, Journal of biomechanics.

[29]  Dobrin Pb Balloon embolectomy catheters in small arteries. I. Lateral wall pressures and shear forces. , 1981 .

[30]  L. Edmunds,et al.  Effect of electrical stimulation on diaphragmatic muscle used to enlarge right ventricle. , 1981, Surgery.

[31]  N. Reichek,et al.  Replacement of ventricular myocardium with diaphragmatic skeletal muscle: short-term studies. , 1981, The Journal of thoracic and cardiovascular surgery.

[32]  W. Glenn,et al.  Evaluation of electrical parameters for diaphragm pacing: an experimental study. , 1981, The Journal of surgical research.

[33]  D. Riley,et al.  A regional histochemical and electromyographic analysis of the cat respiratory diaphragm , 1979, Experimental Neurology.

[34]  Pengelly Ld Mechanical properties of the diaphragm and their application to a mathematical model. , 1979 .

[35]  S. Salmons,et al.  Ultrastructural aspects of the transformation of muscle fibre type by long term stimulation: changes in Z discs and mitochondria. , 1978, Journal of anatomy.

[36]  A. C. Bryan,et al.  Developmental pattern of muscle fiber types in human ventilatory muscles. , 1978, Journal of applied physiology: respiratory, environmental and exercise physiology.

[37]  W. Glenn,et al.  Diaphragm pacing. Application to a patient with chronic obstructive pulmonary disease. , 1978, The Journal of thoracic and cardiovascular surgery.

[38]  G. Sant'ambrogio,et al.  Motion of the rib cage and the abdomen in tetraplegic patients. , 1978, Clinical science and molecular medicine.

[39]  E. Manuelidis,et al.  Diaphragm pacing: histopathological changes in the phrenic nerve following long-term electrical stimulation. , 1976, The Journal of thoracic and cardiovascular surgery.

[40]  S. Salmons,et al.  Significance of impulse activity in the transformation of skeletal muscle type , 1976, Nature.

[41]  J. Sharp,et al.  Mechanics of the canine diaphragm. , 1976, Journal of applied physiology.

[42]  C. W. Caldwell,et al.  A Percutaneous Wire Electrode for Chronic Research Use , 1975, IEEE Transactions on Biomedical Engineering.

[43]  M. Brooke,et al.  THE USE AND ABUSE OF MUSCLE HISTOCHEMISTRY , 1974 .

[44]  D. Riley,et al.  The effects of inactivity, programmed stimulation, and denervation on the histochemistry of skeletal muscle fiber types. , 1973, Experimental neurology.

[45]  H. M. Gunn,et al.  Histochemical fibre types in the mammalian diaphragm. , 1972, Journal of anatomy.

[46]  J. Hogan,et al.  Total ventilatory support in a quadriplegic patient with radiofrequency electrophrenic respiration. , 1972, Proceedings. Veterans Administration Spinal Cord Injury Conference.

[47]  M. Brooke,et al.  Muscle fiber types: how many and what kind? , 1970, Archives of neurology.

[48]  F. Saibene,et al.  Contractile properties of the diaphragm in some mammals. , 1970, Respiration physiology.

[49]  S Salmons,et al.  The influence of activity on some contractile characteristics of mammalian fast and slow muscles , 1969, The Journal of physiology.

[50]  A. Kantrowitz,et al.  Histologic changes in continuous, long-term electrical stimulation of a peripheral nerve. , 1967, IEEE transactions on bio-medical engineering.

[51]  E. Radford,et al.  VENTILATION STANDARDS FOR SMALL MAMMALS. , 1964, Journal of applied physiology.

[52]  K. Akert,et al.  Studies on the innervation of the diaphragm , 1962 .

[53]  W. J. Dixon,et al.  Introduction to Statistical Analysis , 1951 .