Diaphragm pacing in infants and children. A life-table analysis of implanted components

D. E. Weese-Mayer, A. S. Morrow, R. T. Brouillette, M. N. Ilbawi, C. E. Hunt

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

Since 1976, we have implanted bilateral phrenic nerve electrodes for diaphragm pacing in 33 infants and children. This population includes 23 patients with congenital central hypoventilation syndrome (CHS), two with late onset CHS and hypothalamic dysfunction, three with hypoventilation associated with Chiari II malformation and myelomeningocele, and five with quadriplegia. Our experience, totaling 192 system-years and 96 patient-years of pacing, has enabled us to document the nature and frequency of problems related to the implanted components of the Avery Laboratories (S-232-1) pacemaker system when used in a pediatric population. By life table analysis, the mean time to need for replacement of any implanted component was 56.3 months. A total of 26 failures requiring component replacement occurred and were classified into four types: (1) receiver failure (15 cases), (2) electrodes wire or wire insulation breakage (six cases), (3) infection requiring diaphragm pacer system removal (three cases), and (4) mechanical nerve injury (two cases). We conclude that the present diaphragm pacing system is effective but not without risk of biomedical component failure. The present system might be substantially improved by (1) a modified receiver design with a hermetic seal to prevent fluid penetration, (2) stronger, better insulated electrode wires, and (3) modifications of surgical technique and electrode type to prevent phrenic nerve damage.

Original languageEnglish (US)
Pages (from-to)974-979
Number of pages6
JournalAmerican Review of Respiratory Disease
Volume139
Issue number4 I
DOIs
StatePublished - Jan 1 1989

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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