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Cardiac resynchronization therapy（CRT） benefits a portion of patients, while more patients are not yet indicated to a therapy that mechanically helps the heart systole and/or diastole. Synchronized diaphragmatic pacing may be feasible to induce diaphragm local contraction and recoil that enhance pump function of the heart, thus improve cardiac function and QoL.
This acute, interventional study is conducted in a single site, Renji Hospital, to evaluate the feasibility of diaphragm pacing and assess the beneficial effect of pacing-regulated diaphragm movement to the heart, with 10 cases of sample size and one-week follow-up after discharge.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| DSP LIPV group | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DSP | Procedure | For patients with indications for CRT or CRT-D, a pacing electrode delivery sheath is inserted via the subclavian approach following the placement of the atrial electrode as part of the conventional pacemaker implantation procedure. Angiography is performed at the level of the LIPV to visualize its course. Subsequently, a quadripolar ventricular lead is advanced through the sheath into the LIPV to conduct diaphragmatic pacing testing, observing the diaphragmatic pacing effectiveness and its impact on cardiac activity. Upon test completion, the catheter and lead are withdrawn, and the standard pacemaker implantation procedure is continued. |
| Measure | Description | Time Frame |
|---|---|---|
| The feasibility of local diaphragm muscle pacing | To evaluate the success rate of diaphragm pacing and the capability of the electrode to capture the local diaphragm below the cardiac apex, providing a recommendation of venous access and route for the interventional procedure to conduct local electrical stimulation in the diaphragm. | Acute, during the procedure |
| Measure | Description | Time Frame |
|---|---|---|
| The observation of pacing-regulated diaphragm movement for the determination of local diaphragm capture | Intra-procedure | |
| The diameter (or dimension) of the local venous anatomy | Perioperative | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Tianbao Dr. Yao, MD | Contact | +86 13661684786 | yaotianbao@renji.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Renji Hospital | Recruiting | Shanghai | Shanghai Municipality | 200127 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40557395 | Background | Dando L, Howick V JF, Yoo J, Kella DK, McLeod CJ, van Niekerk CJ. Left inferior phrenic vein ICD lead implantation. HeartRhythm Case Rep. 2025 Mar 18;11(6):534-538. doi: 10.1016/j.hrcr.2025.03.010. eCollection 2025 Jun. No abstract available. | |
| 31660505 | Background | McIntosh RA, Ansari MI, Moon J, Khan HR. Delivery of cardiac resynchronization therapy via the left inferior phrenic vein: a case report. Eur Heart J Case Rep. 2019 Sep 16;3(3):ytz144. doi: 10.1093/ehjcr/ytz144. eCollection 2019 Sep. |
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| ID | Term |
|---|---|
| D006333 | Heart Failure |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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|
| DSP lead threshold |
| Intra-procedure |
| Complications of the diaphragmatic synchronized pacing | Perioperative |
| 36088466 | Background | Fujii Y, Koizumi J, Sekiguchi Y, Ono S, Sekiguchi T, Hara T, Hashimoto J. Morphometric assessment of the left inferior phrenic vein in patients with portal hypertension. Sci Rep. 2022 Sep 10;12(1):15275. doi: 10.1038/s41598-022-19610-w. |
| 24464736 | Background | Beeler R, Schoenenberger AW, Bauer P, Kobza R, Bergner M, Mueller X, Schlaepfer R, Zuber M, Erne S, Erne P. Improvement of cardiac function with device-based diaphragmatic stimulation in chronic heart failure patients: the randomized, open-label, crossover Epiphrenic II Pilot Trial. Eur J Heart Fail. 2014 Mar;16(3):342-9. doi: 10.1002/ejhf.20. Epub 2013 Dec 6. |
| 19168496 | Background | Roos M, Kobza R, Jamshidi P, Bauer P, Resink T, Schlaepfer R, Stulz P, Zuber M, Erne P. Improved cardiac performance through pacing-induced diaphragmatic stimulation: a novel electrophysiological approach in heart failure management? Europace. 2009 Feb;11(2):191-9. doi: 10.1093/europace/eun377. |
| 30143910 | Background | Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Teall T, Webb J, Carr-White G, Rinaldi CA. Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions. Heart Fail Rev. 2019 Jan;24(1):41-54. doi: 10.1007/s10741-018-9734-8. |
| 35619238 | Result | Jorbendaze A, Young R, Shaburishvili T, Demyanchuk V, Buriak R, Todurov B, Rudenko K, Zuber M, Stampfli SF, Tanner FC, Erne P, Mirro M, Fudim M, Goldberg LR, Cleland JGF. Synchronized diaphragmatic stimulation for heart failure using the VisONE system: a first-in-patient study. ESC Heart Fail. 2022 Aug;9(4):2207-2214. doi: 10.1002/ehf2.13984. Epub 2022 May 26. |