Thoracic spinal cord stimulation for post-ablation cardiac pain in a patient with permanent pacemaker

Spinal cord stimulation (SCS) is increasingly utilized for inoperable, intractable chest pain because of ischemia. Because patients with ischemic heart disease commonly have permanent cardiac pacemakers (PPM) or automated implantable cardio-defibrillators (AICD), concurrent use of SCS and PPM or AICD may grow. Interference between SCS and PPM or AICD devices is potentially dangerous and has been previously reported.

A 51-year-old woman who underwent multiple catheter-based cardiac ablations for a variety of tachy-atrial arrhythmias. These procedures included atrioventricular node destruction, which left her PPM-dependent (third degree heart block with an intrinsic heart rate in the 30s). During the course of her cardiac treatment, she developed chest pain which was not amenable to cardiac intervention and was refractory to medical management. The patient was evaluated for consideration of SCS and ultimately underwent implantation. Procedures evaluating SCS-PPM compatibility were followed and are described. Immediately after SCS implantation and at 6 months follow-up, the patient experienced improved pain relief.

Others have reported SCS implantation in patients with PPM. This is the first report to describe safe and effective use of an Advanced Bionics SCS in a patient with a Guidant PPM. In addition, we speculate that this patient's cardiac pain may have been other than ischemic in origin. As such, this case may represent a unique clinical scenario. Despite many cases series and case reports demonstrating safety of concurrent SCS and PPM or AICD, the complexity of these technologies requires continued demonstration of device compatibility in novel contexts.