Phrenic nerve stimulation in CRT patients and benefits of electronic lead repositioning: the ERACE trial

  • Stephan Goetze
  • Pascal Defaye
  • Alexander Bauer
  • Matthias Merkel
  • Olivier Bizeau
  • Sven Treusch
  • Klaus Contzen
  • Claus Juenger
  • Joachim Winter
  • on behalf of the ERACE study investigators



Despite novel left ventricular (LV) lead technologies, phrenic nerve stimulation (PNS) remains an adverse effect observed in many patients with cardiac resynchronization therapy (CRT). Beyond anatomic repositioning, modern CRT devices allow avoidance of PNS also by software-based adaption of the pacing configuration. The Electronic Repositioning With Acuity and Easytrak Leads study evaluated the incidence of PNS in a CRT population and examined how often LV lead relocation can be avoided by “electronic repositioning” (ER).


Patients who had an indication for implantation of a first CRT defibrillator with the option of ER were enrolled. Primary endpoint was the efficiency of ER determined by the frequency of PNS with the standard pacing configuration (LV tip to RV coil) avoidable by ER. PNS and pacing parameters were evaluated during implant, predischarge, and first routine follow-up (FU) using four different pacing configurations available by ER.


In total, 292 patients were enrolled and provided with a transvenous LV lead (82.2 % male, 65.5 ± 9.2 years old). The majority of the population was in NYHA III (84.2 %) with a LV ejection fraction of 25.3 ± 6.8 % and mean QRS width of 155 ± 27 ms, ischemic cardiomyopathy was present in 43.6 %. Median FU was 116 days. In the standard pacing configuration, PNS was inducible in 19.0/25.6/24.6 % at implant/predischarge/FU, respectively, resulting in 32.2 % of the patients presenting at least once with PNS. The safety margin for the standard pacing configuration between LV and PNS threshold was <1.0 V at 0.5 ms in 5.6/7.0/5.0 % of the patients, corresponding with a total rate of 11.6 % during the FU. In the finally chosen configuration, clinically relevant PNS occurred in 1.0/2.2/1.3 %. The four vector configurations allowed all but 6 of 292 (2 %) patients to be reprogrammed using ER without reoperation.


The incidence of inducible PNS in CRT patients is considerable. In this study, PNS could be avoided in the majority of the patients by means of electronic repositioning. Thus, the use of ER should be considered for CRT patients.


Cardiac resynchronization Heart failure Phrenic nerve stimulation Electronic repositioning 



We wish to thank the centers for their participation in the ERACE study (enrolled number of patients in brackets). The logistic support for the centers by the responsible study coordinator Mrs. Andrea Ungefehr as well as the data management by Dr. Carsten Morkel (both employees of Boston Scientific) were highly appreciated.

Participating centers: Berlin, Charité—Universitaetsmedizin Berlin, Campus Benjamin Franklin (4), Berlin, Deutsches Herzzentrum Berlin (35), Coburg, Klinikum Coburg gGmbH (7), Dachau, Amper Kliniken AG (2), Duesseldorf, Universitaetsklinikum Duesseldorf (6), Erfurt, Kardiologie am Fischmarkt (3), Erfurt, Kardiologische Gemeinschaftspraxis Dr. Bischoff und Dr. Lang (4), Frankfurt am Main, CCB Cardioangiologisches Centrum Bethanien (8), Hamburg, Asklepios Kliniken Hamburg (5), Hannover, Medizinische Hochschule Hannover (2), Heidelberg, Universitaetsklinikum Heidelberg (24), Karlsruhe, Staedt. Klinikum Karlsruhe gGmbH (16), Landshut, Krankenhaus Landshut-Achdorf (8), Mainz, Johannes-Gutenberg-Universitaet Mainz (4), Muenchen, KGP Dr. Boedigheimer, Dr. Muehling, Prof. Silber (4), Muenchen, Klinik Augustinum Muenchen (1), Muenster, Westf. Wilhelms-Universitaet Muenster Med. Klinik u. Poliklinik C (9), Oldenburg, Klinikum Oldenburg gGmbH (9), Stuttgart, Klinikum Stuttgart Katharinenhospital (8), all Germany

Amiens, CHRU Amiens—Hôpital Sud (4), Angers, CHU (11), Avignon, CH Henri Duffaut (3), Caen, CHU Caen (2), Clamart, Hopital A Béclère (4), Clermont Ferrand, Cl des Dômes (1), Dijon, Hopital du Bocage (4), Fort de France, CHU (2), Grenoble, CHU Albert Michallon (29), La Roche sur Yon, CHD La Roche Yon (6), Lyon, Hopital de la Croix Rousse (1), Marseille, CHP Clairval (2), Marseille, La Timone (1), Nantes, Nouvelles cliniques Nantaises (9), Orleans, CHR Orleans, Hopital La Source (13), Paris, Clinique Bizet (7), Paris, Pitie Salpetrière (4), Pau, Sise au Centre Hospitalier de Pau ( 18), Rennes, Hôpital Pontchaillou (1), Rouen, CHU de Rouen (1), Toulouse, Clinique Pasteur (9), Toulouse, Hopital Rangueil (4), Tours, CHU—Hôpital Trousseau (10), all France.

Conflict of interest

Sven Treusch, MD, and Klaus Contzen, PhD are employees of Boston Scientific Corporation.


This study was sponsored by Guidant/Boston Scientific Int. Inc.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Stephan Goetze
    • 1
    • 9
  • Pascal Defaye
    • 2
  • Alexander Bauer
    • 3
  • Matthias Merkel
    • 4
  • Olivier Bizeau
    • 5
  • Sven Treusch
    • 6
  • Klaus Contzen
    • 6
  • Claus Juenger
    • 7
  • Joachim Winter
    • 8
  • on behalf of the ERACE study investigators
  1. 1.German Heart InstituteBerlinGermany
  2. 2.University of GrenobleGrenobleFrance
  3. 3.University of HeidelbergHeidelbergGermany
  4. 4.Municipal HospitalKarlsruheGermany
  5. 5.CHR OrleansOrleansFrance
  6. 6.Boston ScientificDiegemBelgium
  7. 7.Institute for Research on Myocardial InfarctionLudwigshafenGermany
  8. 8.University of DuesseldorfDuesseldorfGermany
  9. 9.Deutsches Herzzentrum BerlinBerlinGermany

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