Dysfunctional hypoglossal nerve stimulator after electrical cardioversion: A case series

Abstract

Objectives/Hypothesis Upper airway stimulation has demonstrated marked improvements in apnea‐hypopnea index, oxygen desaturation index, and quality‐of‐life measures in patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure. Cardiac arrhythmias are common in patients with OSA and can require electrical cardioversion. We describe the first four reported cases of hypoglossal nerve stimulator (HGNS) dysfunction after electrical cardioversion and illustrate our operative approach to device troubleshooting and repair. Study Design Retrospective case series. Methods A retrospective review of 201 HGNS implantations performed at two academic institutions revealed four cases of HGNS device dysfunction after electrical cardioversion requiring surgical revision. Preoperative and postoperative device performance metrics and electrical cardioversion specifications were retrospectively assessed and compiled for this case series. The senior authors (R.J.S., M.S.B.) detail operative planning and approach for HGNS implantable pulse generator (IPG) replacement. Results At least two patients with HGNS device dysfunction had received cardioversion via anterolateral electrode pad placement. Three patients had received multiple shocks. All four patients experienced a change in device functionality or complete cessation of functionality after electrocardioversion. Operatively, each patient required replacement of the IPG, with subsequent intraoperative interrogation revealing proper device functionality. Conclusion Counseling for patients with HGNS undergoing external electrical cardioversion should include possible device damage and need for operative replacement. Anteroposterior electrode pad placement should be considered for patients with HGNS who require electrocardioversion. Operative replacement of an HGNS system damaged by electrocardioversion begins with IPG replacement and intraoperative device interrogation. Level of Evidence 4 Laryngoscope, 129:1949–1953, 2019

Response to Hypoglossal Nerve Stimulation Changes With Body Mass Index and Supine Sleep

“…Symptoms resolved in 5 patients (71%) after minor interventions or adjustments to the HGNS device. Two patients (29%) did not overcome these adverse events; 1 developed an abscess that ultimately resulted in the explantation of the device, while the other experienced decreased tolerance of HGNS therapy following cardioversion, leading to disrupted sleep and discontinuation of HGNS in favor of PAP therapy …”

Hypoglossal Nerve Stimulator-Induced Neurapraxia Following Electrical Cardioversion for Atrial Fibrillation

“…Failure of an HNS following ECV is a rare occurrence. A previous retrospective review of 201 patients by Vasconcellos et al ( 5 ) reported 4 instances of total device failure following repeated cardioversions for AF or direct cardioversion over the device. The devices in this series represented an older HNS technology that did not have electrical shielding and required surgical device replacement if damaged during ECV ( 6 ).…”

Hypoglossal Nerve Stimulation Therapy for the Treatment of Obstructive Sleep Apnea

“…More serious complications such as device exposure, pneumothorax, wound infection requiring explantation, hematoma requiring evacuation, and device malfunction after cardiac cardioversion have all be described, but are rare in frequency [29,30]. In general, when compared to alternative surgical therapies for the treatment of CPAP-resistant OSA, such as soft tissue surgery and orthognathic procedures, HGNS therapy complication rates are equally as low, if not lower, in these patients.…”