In a recent edition of The Journal of Cardiovascular Electrophysiology, physicians at the Deutsches Herzzentrum München in Munich, Germany report the successful treatment of sinus bradycardia with a cardiac pacemaker in a patient with a diaphragm pacing system.

Chest x-ray shows "a bilateral unipolar diaphragm pacing system...and a concomitantly implanted dual-chamber cardiac pacing system."

"As diaphragm pacing is an accepted technique to maintain breathing in patients with Ondine's curse it may coincide with the indication for cardiac pacing. Our report shows that cardiac pacing is possible despite electromagnetic interference by unipolar diaphragm pacing."

"The use of bipolar cardiac pacing electrodes and achievement of excellent sensing thresholds for the cardiac signals are essential."

"It may be helpful to choose leads with a small dipole distance, to place them perpendicular to the main direction of the electromagnetic field created by the phrenic pacing system, and to place them as far as possible from the diaphragm receiver/stimulator unit (if the diaphragm pacing system is unipolar) or as far as possible from the lead insertion to the phrenic nerve (if the diaphragm pacing system is bipolar)."

"Cardiac pacing in the presence of a unipolar diaphragm pacing system is feasible and safe if thorough testing for possible interdevice interactions is performed."

Kolb C, Eicken A, Zrenner B, Schmitt C. "Cardiac Pacing in a Patient with Diaphragm Pacing for Congenital Central Hypoventilation Syndrome (Ondine's Curse)" J.Cardiovasc.Electrophysiol; Vol.17, pp 1-3, July 2006.