# Case Report: Treatment of ultra-late phrenic nerve stimulation after cardiac resynchronization therapy with double-layer spacer isolation technique

## TL;DR

A patient experienced phrenic nerve stimulation twelve years after heart therapy, which was resolved using a new isolation technique.

## Contribution

The paper introduces a novel double-layer spacer isolation technique to address ultra-late phrenic nerve stimulation.

## Key findings

- Phrenic nerve stimulation occurred twelve years after CRT without lead dislodgement.
- Reprogramming failed, but the double-layer spacer isolation technique successfully isolated the nerve and restored therapy.

## Abstract

Ultra-late phrenic nerve stimulation (PNS) without evidence of lead dislodgement after cardiac resynchronization therapy (CRT) can be frequently solved by reprogramming and seldom leads to reintervention. We reported a case of super-response to CRT patient, PNS occurred after twelve years of the surgery. Reprogramming the parameters was ineffective. We innovatively used a double-layer spacer isolation technique to effectively isolate the left ventricular lead and the phrenic nerve, achieving the effect of cardiac resynchronization therapy.