Possible stabilization of spinal cord stimulation treatment in refractory angina pectoris by implantation of a second...

Patients with refractory angina pectoris usually exhaust conventional treatment of ischemic heart disease. They frequently need opioids and still have angina pectoris despite earlier coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In those cases, treatment strategies including neuromodulation techniques such as transcutaneous electrical neurostimulation (TENS) or spinal cord stimulation (SCS) often are successful. Covering the pain area with electrically induced paraesthesia leads to a reduction in angina incidence, reduced opioid and nitrate consumption, better results under stress test, and better quality of life. A rare complication in treatment of refractory angina pectoris with SCS is repeated electrode displacement. We report three cases where the problem was solved with the implantation of a dual electrode system. After a period with TENS, patients suffering from refractory angina pectoris are normally treated with implantation of a single electrode SCS-system. Presently over 130 devices have been implanted for this indication at our hospital. In three patients, repeated electrode displacement occurred, and despite the attempt to replace the electrode, it was impossible to provoke sufficient paraesthesia in the pain area. These patients were offered the implantation of a dual electrode system where two electrodes are placed in the epidural space. With the dual electrode system, good and stable stimulation was achieved, provoking appropriate paraesthesia. This suggests that two electrodes implanted in the epidural space may stabilize each other mechanically. On the other hand the variety of program adjustments is enlarged, due to the additional poles on the second electrode. On the basis of these case reports, we suggest that implantation of a dual electrode SCS-device might be the solution in case of repeated displacement of a single SCS-electrode.