Korean J Thorac Cardiovasc Surg 2018; 51(5): 363-366  https://doi.org/10.5090/kjtcs.2018.51.5.363
Thoracoscopic Patch Insulation for Phrenic Nerve Stimulation after Permanent Pacemaker Implantation
Yoonjin Kang, M.D.1, Eung Rae Kim, M.D., Ph.D.2, Jae Gun Kwak, M.D., Ph.D.1, Woong-Han Kim, M.D., Ph.D.1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 2Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Sejong General Hospital
Corresponding author: Woong-Han Kim, Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
(Tel) 82-2-760-3637 (Fax) 82-2-3672-3637 (E-mail) woonghan@snu.ac.kr
Received: March 28, 2018; Revised: August 7, 2018; Accepted: August 16, 2018.; Published online: October 5, 2018.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

cc This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properlycited.
Abstract
One of the complications of permanent pacemaker implantation is unintended phrenic nerve stimulation. A 15-year-old boy with a permanent pacemaker presented with chest discomfort due to synchronous chest wall contraction with pacing beats. Even after reprogramming of the pacemaker, diaphragmatic stimulation persisted. Therefore, we performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch to insulate the phrenic nerve from the wire. A minimally invasive approach using a thoracoscope is a feasible option for retractable phrenic nerve stimulation after pacemaker implantation.
Keywords: Minimally invasive surgical procedures, Phrenic nerve, Thoracoscopy, Artificial pacemakers


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