In a recent edition of The Journal of Pacing and Clinical Electrophysiology, physicians at Yale University School of Medicine, Beth Israel Deaconess Hospital, and the UT Houston Medical School report on the long-term results of continuous diaphragmatic pacing.

Longitudinal section at the level of the electrode "shows overall good preservation of myelin" and "no significant axonal loss"

"The authors have previously shown that conditioning of the diaphragm for continuous bilateral pacing is a feasible and effective means of ventilation in patients with complete respiratory paralysis from high cervical (above C3) quadriplegia."

"Twelve quadriplegia patients underwent bilateral phrenic nerve pacemaker placement and diaphragm conditioning from 1981 to 1987."

"Of the 12 patients, 6 continued to pace full time (mean 14.8 years); all were living at home... Despite theoretical concerns about long-term nerve damage, no patient lost the ability to pace the phrenic nerve."

"This follow-up confirms that quadriplegic patients are able to meet long-term, full-time ventilation requirements using phrenic nerve stimulation of the conditioned diaphragm. Careful review of diaphragmatic pacing candidates with respect to associated medical conditions, social support, and motivation is essential for appropriate patient selection and successful long-term results."

Elefteriades JA, Quin JA, Hogan JF, Holcomb WG, Letsou GV, Chlosta WF, Glenn WWL. "Long-Term Follow-Up of Pacing of the Conditioned Diaphragm in Quadriplegia." PACE 2002; 25:897-906.