[Epidural spinal cord stimulation in therapy-resistant angina pectoris]

Area of Science:

• Cardiovascular Medicine
• Neuromodulation
• Pain Management

Background:

• Spinal cord stimulation (SCS) is an established therapy for neurogenic pain and peripheral vascular disease.
• Previous research suggests sympathectomy-like effects of neurostimulation, including improved blood flow and oxygenation.
• The efficacy of SCS for angina pectoris, a severe form of cardiac pain, is explored based on its known benefits in vascular conditions.

Observation:

• Two patients with severe, intractable angina pectoris (NYHA class II-III) and three-vessel disease were treated with SCS.
• Both patients had failed optimal medical therapy and were unsuitable for surgical intervention.
• SCS was delivered via an implanted Medtronic system under local anesthesia, with stimulation parameters adjusted for comfortable paresthesia.

Findings:

• SCS treatment resulted in significant pain relief, sustained for 6 and 12 months in the two patients.
• Both patients demonstrated improved effort tolerance, with a reduction in heart failure severity (NYHA class II/III to NYHA I/II).
• Objective measures showed a slight decrease in heart rate and blood pressure, leading to a diminished rate-pressure product; one patient exhibited ECG normalization.

Implications:

• SCS offers a viable therapeutic option for patients with refractory angina pectoris who are not candidates for surgery.
• The findings suggest SCS can improve quality of life and functional capacity in severe cardiac patients.
• Further research into SCS for cardiovascular conditions may reveal broader applications in managing ischemic heart disease.