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Updated: May 23, 2026

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Burst Spinal Cord Stimulation for Refractory Angina Pectoris: A Prospective Pilot Study-The BAP Study.

Frank Wille1, Maarten Evert Wille2, Xander Zuidema3

  • 1Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands.

Neuromodulation : Journal of the International Neuromodulation Society
|May 22, 2026
PubMed
Summary

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Burst spinal cord stimulation (SCS) significantly improved angina symptoms and quality of life in refractory angina pectoris (RAP) patients compared to conventional SCS. Further trials are needed to confirm these findings for RAP treatment.

Area of Science:

  • Cardiology
  • Neurology
  • Pain Management

Background:

  • Refractory angina pectoris (RAP) presents limited treatment options, with moderate evidence supporting conventional spinal cord stimulation (SCS).
  • Emerging subthreshold SCS modes show promise for ischemic pain, but their efficacy in RAP remains under-investigated.
  • Previous case reports suggest burst SCS may be more effective than conventional SCS for RAP.

Purpose of the Study:

  • To evaluate the efficacy and safety of transitioning from conventional SCS to burst SCS in patients with refractory angina pectoris (RAP).
  • To assess changes in angina symptoms, quality of life, and patient satisfaction after switching to burst SCS.

Main Methods:

  • A prospective pilot study involving ten patients previously treated with conventional SCS.
Keywords:
Burst stimulationrefractory angina pectorisspinal cord stimulationsubthreshold stimulation

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  • Patients' SCS programs were converted to burst SCS, with outcomes assessed at baseline and one-month follow-up.
  • Seattle Angina Questionnaire (SAQ), EQ-5D-3L, and patient satisfaction were recorded. Primary outcome was SAQ summary score.

    • Main Results:

    • The median SAQ summary score improved from 60 to 79 points at one-month follow-up with burst SCS.
    • Patient follow-up was complete for all ten participants over a 3.5-year period.
    • One serious adverse event (AE) and one AE were reported during the study.

    Conclusions:

    • Burst SCS demonstrated a substantial improvement in angina symptoms and quality of life compared to conventional SCS in this pilot study.
    • The findings suggest burst SCS may be a beneficial treatment for refractory angina pectoris.
    • Larger randomized controlled trials are warranted to validate these promising results and establish burst SCS for RAP.