Phrenic Nerve Implant (Stimulator)
© Blue Cross and Blue Shield of Montana
Current Effective Date:
September 24, 2013
Original Effective Date:
September 24, 2013
June 24, 2013
Hypoventilation is a state in which an abnormally low amount of air enters the lungs during respiration. A phrenic nerve implant (stimulator) is an implanted device that provides electrical stimulation to the patient’s phrenic nerve to contract the diaphragm rhythmically and produce breathing in patients who have hypoventilation. This device has been used successfully to treat hypoventilation caused by a variety of conditions, including respiratory paralysis resulting from lesions of the brain stem and cervical spinal cord and chronic pulmonary disease with ventilatory insufficiency. The phrenic nerve stimulator is intended to be an alternative to management of patients with respiratory insufficiency who are dependent upon the usual therapy of intermittent or permanent use of a mechanical ventilator. The integrity of the diaphragm and the phrenic nerves is required to provide adequate ventilation by electrical pulsing or stimulation.
Phrenic nerve implantation or stimulation is also known as:
- Electrophrenic Respiration (REP)
- Transvenous Electrophrenic Respiration (EPR)
- Electrophrenic Nerve Pacing (EPP)
- Electrophrenic Pacemaker
- Functional Electrical Stimulation (FES) of Phrenic Nerve
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- Electrophrenic Pacemaker. Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (1989 November) 39599.0-39599.1.
- Talonen, P.P., Baer, G.A., et al. Neurophysiological and technical considerations for the design of an implantable phrenic nerve stimulator. Medical and Biological Engineering and Computing (1990 January) 28(1): 31-37.
- Bach, J.R. and K. O’Connor. Electrophrenic Ventilation: a different perspective. Journal of the American Paraplegia Society (1991 January) 14(1): 9-17.
- Brule, J.F., Leriche, B., et al. Patients with high spinal cord injuries: evaluation of diaphragmatic function, indication of electrophrenic ventilation. Agressologie (1993) 34 (Spec No 2): 90-92.
- Krieger, A.J., Gropper, M.R., et al. Electrophrenic respiration after intercostal to phrenic nerve anastomosis in a patient with anterior spinal artery syndrome: technical case report. Neurosurgery (1994 October) 35(4): 760-764.
- Staton, G., and R. Ingram. Disorders of the Chest Wall. Scientific American, Inc. (1994 January) 1 - 12.
- Fritz, U., Braunn, U., et al. Implantation of a phrenic stimulator in central respiratory paralysis. Anesthetist (1995 December) 44(12): 880 - 883.
- Girsch, W., Koller, R., et al. Vienna phrenic pacemaker—experience with diaphragm pacing in children. European Journal of Pediatric Surgery (1996 June) 6(3):140-3.
- Garrido-Garcia, H., Mazaira Alvarez, J., et al. Spinal Cord (1998 May) 36(5):310-4.
- Centers for Medicare and Medicaid Services – Phrenic Nerve Stimulator. Pub. No. 100-3, Manual Section No. 160.19. Long-standing NCD, effective date not posted. http://www.cms.hhs.gov (Accessed April 26, 2006)
- Electrophrenic Pacemaker. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2005 January) Surgery 7.01.37.