Elsevier

The American Journal of Cardiology

Volume 180, 1 October 2022, Pages 155-162
The American Journal of Cardiology

Transvenous Phrenic Nerve Stimulation for Central Sleep Apnea

https://doi.org/10.1016/j.amjcard.2022.06.038Get rights and content

RespiCardia remedē System (Minnetonka, MN 2017), a transvenous phrenic nerve stimulator, is indicated to treat central sleep apnea (CSA) by stimulating the phrenic nerve to cause diaphragmatic contraction to restore normal breathing during sleep. CSA is associated with decreased patient quality of life and worsens cardiovascular outcomes. Systematic review was conducted according to the Preferred Reporting of Systematic Reviews and Meta-Analysis guidelines. PubMed/MEDLINE, Cochrane, EBSCO CINAHL, and Ovid databases were queried by 2 independent reviewers for English-language studies published between 2000 and 2021. The initial search screened for all occurrences of “remedē” then was further refined to include studies evaluating use of the RespiCardia remedē System as a treatment for CSA in multiple patients. A total of 124 articles were identified from the initial search results. A total of 37 articles were identified through screening of title and abstracts from initial results. Full-text review of all the articles was then completed. Of the 13 articles included, a total of 232 patients underwent device implantation. We sought to summarize the available evidence regarding patient selection for implantation, immediate and delayed complications, adherence to therapy, and polysomnographic evidence of efficacy. All 13 articles detailed significant decreases in central apnea index and many patients reported significant mild to marked improvement in quality of life. In conclusion, the remedē System has been demonstrated to improve sleep and respiratory parameters, with few complications. This device demonstrates safe and effective treatment of moderate to severe CSA in adult patients, including those with heart failure.

Introduction

RespiCardia remedē System, a transvenous phrenic nerve stimulator, was approved in 2017 to treat central sleep apnea (CSA) in certain patients. The pathogenesis underlying development of CSA is multifold, comprising an increase in sensitivity to changes in arterial blood carbon dioxide levels, an increase in circulation time (time it takes for blood to circulate throughout the cardiovascular system), and an increase in plant gain (change in blood gasses per unit change in ventilation).1 The summative effect results in hyperventilation (hyperpnea), followed by decreased (hypopnea) or lack of breathing (apnea), termed Cheyne-Stokes respirations (CSR).2,3 These cyclical episodes cause the release of norepinephrine secondary to increased sympathetic stimulation, which may contribute to progressive worsening of cardiac function and an increased risk for arrhythmias.4 Prognostically, worsening CSA, coupled with hyperventilation and upright CSR, which normally occur while supine, leads to worse clinical conditions and an increased risk of mortality.5,6 This systematic review aimed to outline the success of the remedē System in treating CSA in terms of patient selection, complications, adherence, and efficacy.

Section snippets

Methods

Systematic review was conducted according to the Preferred Reporting of Systematic Reviews and Meta-Analysis guidelines and registered with the International Prospective Registry of Systematic Reviews database. PubMed/MEDLINE, Cochrane, EBSCO CINAHL, and Ovid databases were queried by 2 independent reviewers for English-language full-text articles published between 2000 and 2021. The initial search screened for all occurrences of “remedē”, then was further refined to include studies evaluating

Results

A total of 124 articles were identified from initial search results: 35 articles from PubMed/MEDLINE, 15 from Cochrane, 30 from EBSCO CINAHL, and 44 from Ovid (Figure 1). A total of 37 articles were identified through screening of title and abstracts from initial results. Full-text review of all the articles was then completed. All articles were published after 2010. Of the 13 articles included, a total of 232 patients underwent device implantation (Table 1). It should be noted that the

Discussion

The RespiCardia remedē System is transvenous phrenic nerve stimulation, leading to periodic physiologic contractions of the diaphragm. The remedē System resulted in significant improvements in CSA, Cheyne-Stokes respiration, sleep architecture, and QOL in patients with and without heart failure.23, 24, 25 The phrenic nerve stimulation system is a revolution in terms of CSA treatment in HF. However, it does not treat the pathophysiologic background of this respiratory abnormality and does not

Disclosures

The authors have no conflicts of interest to declare.

References (25)

  • S Joseph et al.

    A novel therapeutic approach for central sleep apnea: phrenic nerve stimulation by the remedē system

    Int J Cardiol

    (2016)
  • O Oldenburg et al.

    Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients

    Eur Heart J

    (2016)
  • Cited by (0)

    Funding: None.

    View full text