1004 Transvenous Phrenic Nerve Stimulator, Beyond Good Night Sleep

Abstract Introduction Transvenous phrenic nerve stimulator (TPNS) is effective therapy for central sleep apnea (CSA) in patient with cardiovascular disease. However, its impact on obstructive sleep apnea and atrial fibrillation remain unclear. Methods Objective is to describe our six-year experience using TPNS for CSA in patient with cardiovascular disease and evaluate its effects on OSA and atrial fibrillation. We performed a multi-institutional prospective cohort study of patients with moderate to severe CSA who underwent TPNS implantation from August 2019 to the present. Baseline characteristics and outcomes were collected prospectively. Polysomnography (PSG) results prior to implantation were compared with PSG post-optimization studies, and AF presence 6 month before and 6 month after TPNS optimization was assessed. Results A total of 38 devices were successfully implanted. Two patients (5%) experienced lead dislodgment requiring re-implantation; no other peri-procedural complications occurred. The cohort’s mean age was 68.69 ± 10.42 years, with a mean CHADS-VASc score of 2 ± 1.86. Sixteen of the 38 patients underwent optimization with polysomnography (PSG). Significant improvements were observed in: Apnea–Hypopnea Index (AHI): 43.4 ± 25.1 pre-treatment vs 21.2 ± 15.49 post-treatment (p = 0.03) Central sleep apnea events: 106.6 ± 75.07 pre vs 17.71 ± 17.93 post (p < 0.01) Mixed sleep apnea events: 25.06 ± 47.29 pre vs 1.67 ± 3.11 post (p = 0.05) Obstructive sleep apnea events: 9 ± 10 pre vs 23.5 ± 31.97 post (p = 0.03) Atrial fibrillation was present in 6 of 17 patients pre-treatment compared with 3 of 17 post-treatment (p = 0.03). Five of the six patients with atrial fibrillation had cardiac implantable electronic devices. The total average atrial fibrillation burden in these five patients was 100% before therapy and decreased to 66% after therapy (p = 0.08) Conclusion TPNS provides effective therapy for central, mixed sleep apnea, and marked improvements in AHI. Although obstructive sleep apnea events increased, atrial fibrillation burden improved following TPNS therapy. Further research is warranted, and careful patient selection remains critical Support (if any)