Treatment of recurrent chest pain in a heart transplant recipient using spinal cord stimulation

A patient presented with chest pain refractory to conventional medical therapy eight years after heart and renal transplantation. High-dose opioids provided limited relief and repeated hospitalisation was required. Angiography demonstrated severe cardiac allograft vasculopathy, unsuitable for percutaneous or surgical intervention. Reports of sympathetic re-innervation of the transplanted heart encouraged us to undertake a trial of spinal cord stimulation. This was successful so we proceeded to permanent implantation. The patient was weaned from opioids and after six months had needed no further hospital admissions. We recommend consideration of spinal cord stimulation in patients with features of angina pectoris following heart transplantation.