Diaphragmatic Pacing

Diaphragmatic pacing, also called phrenic nerve pacing, is a treatment that postpones or eliminates the need for machine-assisted breathing in people with diaphragm injury, weakness or paralysis.

Key info

  • Diaphragmatic pacing is a surgical treatment for those with diaphragm weakness or paralysis due to nerve injury
  • Diaphragmatic pacing involves placing a pacer that regulates diaphragm function, relaying the message to expand contract - facilitating breathing

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 diaphragmatic 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, one is able to breathe without ventilation support and can close their tracheostomy. Many people 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

Next Steps

If you need help for a lung or chest issue, we’re here for you. Call (212) 305-3408 for existing patients, (212) 304-7535 for new patients, or request an appointment online to get started today.

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