Diaphragmatic pacing, also called phrenic nerve pacing, is a treatment that postpones or eliminates the need for machine-assisted breathing in patients with diaphragm injury, weakness or paralysis.
What is diaphragmatic pacing?
A specially-trained thoracic surgeon places a pacemaker within the diaphragm muscle during a minimally-invasive surgery. That pacemaker is connected to an external transmitter that gives ongoing electric impulses to the electrodes, causing the diaphragm to contact and pull air into the lungs.
Is diaphragmic pacing an option for you?
Those who benefit from diaphragmatic pacing are those who are unable to control their breathing voluntarily and need mechanical assistance. Diaphragmatic weakness or paralysis may stem from a congenital condition, such as central hypoventilation syndrome, or an injury where the phrenic nerves have stayed intact.
Anyone with a nerve injury or a spinal cord injury below the C2 vertebra are not candidates for diaphragmatic pacing. If the phrenic nerves have been damaged, diaphragmatic pacing is not an option.
What happens after surgery?
Transitioning from a ventilation machine to the pacemaker involves conditioning and strengthening the diaphragm through specially-developed diaphragmatic breathing exercises and can take weeks to months.
After the surgery, patients are able to breathe without ventilation support and can close their tracheostomy. Many patients also regain the ability to speak after diaphragmatic pacing.
What are the risks associated with diaphragmatic pacing?
Diaphragmatic pacing is a minimally invasive procedure with a complication rate less than 1% percent. Many of the risks are associated with all types of surgery, and especially thoracic surgery.
- Infection, such as pneumonia
- Pacemaker becoming dislodged
- Pacemaker hardware malfunction
- Obstruction of the airway during sleep
- Damage to the phrenic nerves
- Lung injury
- Puncturing of the diaphragm
- Generalization of pacemaker signal, which stimulates other nerves and can result in jerking movements
- Capnothorax, or the accumulation of carbon dioxide in the thoracic cavity
Under the leadership of Mark Ginsburg, MD, co-director of our dedicated Diaphragm Center, Columbia offers diaphragmatic pacing to adults and children, and is one of the world’s highest volume centers for this surgery for the past 20 years. Visit our Diaphragm Center or call 212.305.3408 for more information.