Effects of spinal cord stimulation on myocardial ischaemia during daily life in patients with severe coronary artery disease. A prospective ambulatory electrocardiographic study.

M. J. de Jongste, J. Haaksma, R. W. Hautvast, H. L. Hillege, P. W. Meyler, M. J. Staal, J. E. Sanderson, K. I. Lie

Department of Cardiology, University Hospital of Groningen, The Netherlands.

BACKGROUND--Spinal cord stimulation (SCS) may be a useful additional therapy for pain in patients with therapeutically refractory angina pectoris. But doubts remain about whether it also relieves ischaemia. METHODS--Indices of ischaemia were studied with and without SCS in 10 patients with otherwise intractable angina and evidence of myocardial ischaemia on 48 h ambulatory electrocardiographic (ECG) recording. Primary end points assessed by 48 h ECG recordings were total ischaemic burden, number of ischaemic episodes, and duration of ischaemic episodes. In addition, symptoms were assessed by a diary of glyceryl trinitrate intake and angina attacks. RESULTS--During SCS the total ischaemic burden of the entire group was significantly reduced from a median of 27.9 (1.9-278.2) before SCS to 0 (0-70.2) mm x min with SCS (p < 0.03). In six out of the 10 patients there was no myocardial ischaemia during 48 h ambulatory ECG monitoring with SCS. The number of ischaemic episodes was reduced from a median of 3 (1-15) before SCS to 0 (0-9) with SCS (p < 0.04). The duration of ischaemic episodes decreased from a median of 20.6 (1.7-155.4) min before SCS to 0 (0-48.3) min with SCS (p < 0.03). This was accompanied by a significant improvement in symptoms with a reduction in daily glyceryl trinitrate intake from a median of 3.0 (0-10) before SCS to 0.3 (0-10) tablets per 48 h (p < 0.02) and a decrease in the frequency of anginal attacks from a median of 5.5 (2-14) before SCS to 1.0 (0-10) per 48 h with SCS (p < 0.03). CONCLUSIONS--SCS not only reduced symptoms but also myocardial ischaemia. Therefore, SCS appears to be both a safe and an effective therapy for patients with refractory angina.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Neurostimulation and myocardial ischaemia.

A Chauhan
Heart 1994 72: 595. [PDF]

This article has been cited by other articles:

• Arnold, S. V., Spertus, J. A., Ciechanowski, P. S., Soine, L. A., Jordan-Keith, K., Caldwell, J. H., Sullivan, M. D. (2009). Psychosocial Modulators of Angina Response to Myocardial Ischemia. Circulation 120: 126-133 [Abstract] [Full Text]  
• de Vries, J., DeJongste, M. J.L., Tio, R. A. (2006). An open label, single-centre, randomized trial of spinal cord stimulation vs. percutaneous myocardial laser revascularization in patients with refractory angina pectoris: the SPiRiT trial. Eur Heart J 27: 1631-1632 [Full Text]  
• Lanza, G. A., Sestito, A., Sgueglia, G. A., Infusino, F., Papacci, F., Visocchi, M., Ierardi, C., Meglio, M., Bellocci, F., Crea, F. (2005). Effect of spinal cord stimulation on spontaneous and stress-induced angina and 'ischemia-like' ST-segment depression in patients with cardiac syndrome X. Eur Heart J 26: 983-989 [Abstract] [Full Text]  
• Yang, E. H., Barsness, G. W., Gersh, B. J., Chandrasekaran, K., Lerman, A. (2004). Current and Future Treatment Strategies for Refractory Angina. Mayo Clin Proc. 79: 1284-1292 [Abstract]  
• Svorkdal, N. (2004). Treatment of Inoperable Coronary Disease and Refractory Angina: Spinal Stimulators, Epidurals, Gene Therapy, Transmyocardial Laser, and Counterpulsation. SEMIN CARDIOTHORAC VASC ANESTH 8: 43-58 [Abstract]  
• Moore, R, Groves, D, Nolan, J, Scutt, D, Pumprla, J, Chester, M R (2004). Altered short term heart rate variability with spinal cord stimulation in chronic refractory angina: evidence for the presence of procedure related cardiac sympathetic blockade. Heart 90: 211-212 [Full Text]  
• Andersen, C. (2002). Electrical stimulation vs CAB. Eur Heart J 23: 1896-1897  
• Ekre, O., Eliasson, T., Norrsell, H., Wahrborg, P., Mannheimer, C. (2002). Long-term effects of spinal cord stimulation and coronary artery bypass grafting on quality of life and survival in the ESBY study. Eur Heart J 23: 1938-1945 [Abstract]  
• Mannheimer, C., Camici, P., Chester, M.R., Collins, A., DeJongste, M., Eliasson, T., Follath, F., Hellemans, I., Herlitz, J., Luscher, T., Pasic, M., Thelle, D. (2002). The problem of chronic refractory angina. Report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J 23: 355-370 [Full Text]  
• Moore, R., Chester, M. (2001). Neuromodulation for chronic refractory angina. Br Med Bull 59: 269-278 [Abstract] [Full Text]  
• Murray, S, Collins, P D, James, M A (2000). Neurostimulation treatment for angina pectoris. Heart 83: 217-220 [Full Text]  
• TenVaarwerk, I A M, Jessurun, G A J, DeJongste, M J L, Andersen, C, Mannheimer, C, Eliasson, T, Tadema, W, Staal, M J (1999). Clinical outcome of patients treated with spinal cord stimulation for therapeutically refractory angina pectoris. Heart 82: 82-88 [Abstract] [Full Text]  
• Murray, S, Carson, K G S, Ewings, P D, Collins, P D, James, M A (1999). Spinal cord stimulation significantly decreases the need for acute hospital admission for chest pain in patients with refractory angina pectoris. Heart 82: 89-92 [Abstract] [Full Text]  
• Mannheimer, C., Eliasson, T., Augustinsson, L.-E., Blomstrand, C., Emanuelsson, H., Larsson, S., Norrsell, H., Hjalmarsson, A. (1998). Electrical Stimulation Versus Coronary Artery Bypass Surgery in Severe Angina Pectoris : The ESBY Study. Circulation 97: 1157-1163 [Abstract] [Full Text]