Phrenic Nerve Reconstruction with Short-Term Diaphragm Pacing Corrects Diaphragm Paralysis Due to Intrathoracic Nerve Injury.
Level 4 - case-series / case-control
Retrospective case series without a comparison group
PubMed 39592192 · doi:10.1097/PRS.0000000000011901
What was done
A retrospective case series evaluated 34 consecutive patients (23 men, 11 women; mean age 46 years; mean BMI 28.5 kg/m²) with symptomatic diaphragm paralysis due to intrathoracic phrenic nerve injury. Inclusion criteria required fluoroscopy-confirmed paralysis, BMI under 40, age under 75 years, and preserved motor units on electromyography. Patients underwent intrathoracic phrenic nerve reconstruction combined with simultaneous diaphragm pacemaker implantation.
What was found
Subjective improvement in respiratory function occurred in 88% of patients (30/34). Forced vital capacity increased by 15% (P = 0.02) and forced expiratory volume in 1 second increased by 14% (P = 0.049). Diaphragm motor amplitude rose 375%, from 0.04 mV to 0.19 mV (P = 0.02). Radiographic improvement in resting diaphragm position and contraction was documented in 71% of patients. Complications included pacemaker site infection (5%), cardiac arrhythmia (5%), and asymptomatic abdominal bulge (3%).
Why it matters
This study provides single-center evidence that microsurgical phrenic nerve repair paired with temporary pacing can restore functional diaphragm movement and alleviate respiratory symptoms after intrathoracic nerve damage.
Limits
The study is limited by its retrospective, single-arm design without a control group to isolate the effect of pacing versus reconstruction alone or natural history. The sample size is small (n = 34), and follow-up duration was not reported in the abstract.
Cited by
- supports The phrenic nerve is the nerve responsible for controlling the diaphragm.