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Intraoperative analysis of cross-talk inhibition between diaphragmatic and cardiac pacemakers

Diaphragmatic pacing is advocated in select patients with ventilatory failure due to weakness or paralysis of the diaphragm to eliminate or reduce the need for ventilatory support and to enhance quality of life. In our case, a 65-year-old ventilator-dependent tetraplegic male underwent diaphragmatic pacing with a NeuRx Diaphragm Pacing System (DPS) (Synapse Biomedical, USA) after sustaining a complete C1 spinal fracture. Prior to surgery, the patient required a dual chamber (right atrium and right ventricular apex) permanent cardiac pacemaker (Versa, Medronics, USA) for episodes of asystole. A limitation of right ventricular (RV) apical pacing is far-field R-wave oversensing, that is, processing of signals originating from myopotentials from nearby muscular structures such …