[Neuromodulation as an alternative method in the treatment of refractory angina pectoris]

Epidural stimulation of the spinal cord affects the activation of afferent nerve fibres. Patients refractory to conventional therapy of angina pectoris can be treated with epidural stimulation since 1985. The stimulation electrode is inserted by a small incision to the skin at Th4-Th5 and positioned to the epidural space at Th1-C7. The impulse generator is implanted to the lateral abdominal wall and connected to the stimulation electrode. This treatment should be restricted to patients refractory to--or not suited for--surgical and catheter-based coronary revascularisation. Clinical trials demonstrated increased exercise tolerance, reduction in severity of exertional angina and ST-depression and reduction of nitrate dosage. No impairment of overall prognosis by neuromodulation has been shown in several clinical studies. Epidural spinal cord stimulation represents an alternative therapy for the treatment of selected patients with angina pectoris refractory to conventional therapy.