What Is Diaphragmatic Pacing?
Diaphragmatic pacing is a treatment that improves breathing for people who rely on a mechanical ventilator. It stimulates the phrenic nerve, the nerve in your neck that sends signals to your diaphragm. Your diaphragm is a muscle that pulls air into your lungs as you breathe. Diaphragmatic pacing is also called a diaphragmatic pacemaker or a diaphragmatic pacing system.
A diaphragmatic pacing system has three parts:
- Electrodes that a thoracic surgeon fastens to your phrenic nerve, which connects to a receiver implanted under your skin
- Antenna that stick to the outside of your chest (sensors)
- A battery-operated (AA), lightweight device outside your body that controls the sensors and electrodes
The device connects wirelessly to the sensors outside your body. These antenna tell the electrodes to stimulate your phrenic nerve. This stimulation makes your nerve send signals to your diaphragm. Then your diaphragm contracts and pulls air into your lungs. The system allows many people to breathe without mechanical ventilation.
Who Qualifies for the Diaphragmatic Pacing System?
Diaphragmatic pacing usually treats people with a spinal cord injury affecting their phrenic nerve function. Spinal cord injuries that affect the phrenic nerve are called high spinal cord injuries because they occur higher on your spinal cord. These injuries cause paralysis (loss of movement) in all of your limbs and most of your body (quadriplegia).
People who have central hypoventilation syndrome may also qualify for the diaphragmatic pacing system. Central hypoventilation syndrome is a present-at-birth condition that makes your diaphragm stop working when you sleep. This condition is extremely rare. It affects about 1,000 people globally, according to the National Organization for Rare Disorders.
“I can now drive my wheelchair without someone having to drag the ventilator behind me. It makes life so much easier."
Benefits & Risks of a Diaphragm Pacemaker
A diaphragmatic pacemaker can improve your quality of life if you depend on mechanical ventilation. Many people who get the diaphragmatic pacemaker can reduce or stop using mechanical ventilation. Your tracheostomy may even close if you don’t need the ventilator anymore. A tracheostomy is a surgical opening in your neck where the ventilator connects.
The treatment can offer multiple benefits:
- Decreased reliance on a mechanical ventilator
- Lower risk of infection or pneumonia due to tracheostomy
- More natural breathing sensations
- Possible total freedom from mechanical ventilator use
- Helping with speech
The diaphragmatic pacemaker also brings you much more freedom and independence. The device is small, lightweight, and wireless. You no longer need a support person to carry the ventilator behind you.
The main risk of the diaphragmatic pacing system is that it doesn’t always work. In some cases, phrenic nerve damage is too severe for the treatment to be effective.
Your surgeon will test the device’s effectiveness during the operation. They may choose not to implant the electrodes if your phrenic nerve isn’t responding to them.
Watch Patient Johnny Lesny Drake's Diaphragmatic Pacing Journey
What to Expect at Your Diaphragmatic Pacing Consultation
Your initial consultations for diaphragmatic pacing involve meeting with several specialists:
- Physical medicine and rehabilitation (PM&R) physician
- Pulmonary critical care physician
- Thoracic surgeon
We aim to schedule your visits with these specialists over 1‑3 days to increase efficiency and help you start treatment sooner. Each consultation may last up to an hour to ensure all your questions are answered by each specialist and to adequately evaluate your candidacy for the device.
You may have several tests with your PM&R and pulmonary critical care physicians:
- Blood and imaging tests to assess your overall health
- Electromyography (EMG) tests, part of an electrodiagnostic study, to evaluate your phrenic nerve function
- Pulmonary function tests to check your lung health and function
Your pulmonary and PM&R phsysician manage your care before and after surgery. They recommend and explain treatments and answer your questions.
Your thoracic surgeon performs the procedure to implant the electrodes. They discuss the surgical technique, risks, and benefits with you during your initial consultation.
Diaphragm Pacemaker Surgery
University of Utah Health thoracic surgeons use robotic techniques to perform diaphragmatic pacemaker surgery. Your surgeon makes small incisions and uses robotic arms to operate. This technique is less invasive and more precise than traditional open approaches.
You will be put to sleep under general anesthesia for the procedure. Your surgeon completes several steps during diaphragm pacemaker surgery:
- Makes three half-inch incisions (cuts) along the right side of your chest
- Locates your phrenic nerve
- Uses the robotic arms to sew the electrodes around your phrenic nerve
- Connects the electrodes to the pacing device to test its function
- Closes the incisions
- Repeats the same process on the left side of your chest
Surgery takes about an hour and a half.
After Surgery
You will spend one night in the intensive care unit to make sure you don’t experience breathing problems. Most people return home the next day.
Most patients with high spinal cord injuries that affect sensation may notice mild discomfort, but will not have significant pain.
You will have some chest soreness if you had the procedure to treat central hypoventilation syndrome. You still have sensation throughout your body with this condition. This discomfort usually lasts around two weeks but will be controlled with pain medication.
There will be a two-week waiting period for healing before turning on the device for use.
Follow-Up Care
You will see your thoracic surgeon, PM&R physician, and pulmonary critical care physician about two weeks after the procedure. Your thoracic surgeon will check your incisions to make sure you’re healing properly.
Your PM&R and pulmonary critical care physicians will turn on the pacing device in the clinic so you can experience breathing with it. They will tell you how to use the device and instruct you to increase your time with it gradually. For example, you may start using the pacemaker for 10 minutes per day. Over time, you will use the pacemaker more and your mechanical ventilator less. This transition process can take several weeks to months and your PM&R and pulmonologist will help you guide this process
Find a Doctor
Why Choose U of U Health?
The Spinal Cord Injury Program at Craig H. Neilsen Rehabilitation Hospital is unmatched in the Mountain West region. Your care is in the hands of highly trained, experienced specialists. Our team includes a PM&R physician and a pulmonary critical care doctor with specialized training in spinal cord injuries. These physicians, along with our thoracic surgeon, are global leaders in their fields.
We work closely with each other and you so you receive seamless, coordinated care. We schedule your visits efficiently so you get timely care. Our team helps you find and reserve accessible lodging if you’ve traveled from out of town and need to stay in the area for several weeks. We also conduct follow-up visits via telemedicine so you get the care you need from the comfort of your home.
- Only program in the Mountain West using the wireless pacing system
- Leaders in robotic surgery for diaphragmatic pacemakers
- Access to international physician leaders in PM&R, pulmonary critical care, and thoracic surgery
Rehabilitation Resources
Self-Care Guide for Spinal Cord Injury Patients
The goal of rehabilitation is to help you design a lifestyle that will allow you to function as independently as possible within the realm of your ability. This manual covers many things you learn while you are in the hospital that you can use at home. Yes, You Can! courtesy of Paralyzed Veterans of America.
Spinal Cord Injury & Fertility
Some patients with a spinal cord injury may have erectile and/or ejaculatory dysfunction. Our fertility specialists are highly trained in treating these types of disorders to help get your sexual function back.
Meet Our Patients
In summer 2023, John Lesny Drake was attending Cadet Troop Leader Training with the U.S. Army Reserve at Fort Bliss, Texas. Having a few days off, John joined friends at a nearby lake. To cool off, John dived off the back of a boat into shallow water. John's head hit the sandy bottom, resulting in a spinal cord injury.
