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. 1994 May;71(5):413–418. doi: 10.1136/hrt.71.5.413

Effects of spinal cord stimulation on myocardial ischaemia during daily life in patients with severe coronary artery disease. A prospective ambulatory electrocardiographic study.

M J de Jongste 1, J Haaksma 1, R W Hautvast 1, H L Hillege 1, P W Meyler 1, M J Staal 1, J E Sanderson 1, K I Lie 1
PMCID: PMC483715  PMID: 8011403

Abstract

BACKGROUND--Spinal cord stimulation (SCS) may be a useful additional therapy for pain in patients with therapeutically refractory angina pectoris. But doubts remain about whether it also relieves ischaemia. METHODS--Indices of ischaemia were studied with and without SCS in 10 patients with otherwise intractable angina and evidence of myocardial ischaemia on 48 h ambulatory electrocardiographic (ECG) recording. Primary end points assessed by 48 h ECG recordings were total ischaemic burden, number of ischaemic episodes, and duration of ischaemic episodes. In addition, symptoms were assessed by a diary of glyceryl trinitrate intake and angina attacks. RESULTS--During SCS the total ischaemic burden of the entire group was significantly reduced from a median of 27.9 (1.9-278.2) before SCS to 0 (0-70.2) mm x min with SCS (p < 0.03). In six out of the 10 patients there was no myocardial ischaemia during 48 h ambulatory ECG monitoring with SCS. The number of ischaemic episodes was reduced from a median of 3 (1-15) before SCS to 0 (0-9) with SCS (p < 0.04). The duration of ischaemic episodes decreased from a median of 20.6 (1.7-155.4) min before SCS to 0 (0-48.3) min with SCS (p < 0.03). This was accompanied by a significant improvement in symptoms with a reduction in daily glyceryl trinitrate intake from a median of 3.0 (0-10) before SCS to 0.3 (0-10) tablets per 48 h (p < 0.02) and a decrease in the frequency of anginal attacks from a median of 5.5 (2-14) before SCS to 1.0 (0-10) per 48 h with SCS (p < 0.03). CONCLUSIONS--SCS not only reduced symptoms but also myocardial ischaemia. Therefore, SCS appears to be both a safe and an effective therapy for patients with refractory angina.

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Selected References

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  1. Barry J., Selwyn A. P., Nabel E. G., Rocco M. B., Mead K., Campbell S., Rebecca G. Frequency of ST-segment depression produced by mental stress in stable angina pectoris from coronary artery disease. Am J Cardiol. 1988 May 1;61(13):989–993. doi: 10.1016/0002-9149(88)90112-9. [DOI] [PubMed] [Google Scholar]
  2. Cohn P. F. Total ischemic burden: definition, mechanisms, and therapeutic implications. Am J Med. 1986 Oct 20;81(4A):2–6. doi: 10.1016/0002-9343(86)90971-x. [DOI] [PubMed] [Google Scholar]
  3. Deanfield J. E., Shea M., Ribiero P., de Landsheere C. M., Wilson R. A., Horlock P., Selwyn A. P. Transient ST-segment depression as a marker of myocardial ischemia during daily life. Am J Cardiol. 1984 Dec 1;54(10):1195–1200. doi: 10.1016/s0002-9149(84)80066-1. [DOI] [PubMed] [Google Scholar]
  4. Deedwania P. C., Nelson J. R. Pathophysiology of silent myocardial ischemia during daily life. Hemodynamic evaluation by simultaneous electrocardiographic and blood pressure monitoring. Circulation. 1990 Oct;82(4):1296–1304. doi: 10.1161/01.cir.82.4.1296. [DOI] [PubMed] [Google Scholar]
  5. Eriksson M. B., Sjölund B. H., Nielzén S. Long term results of peripheral conditioning stimulation as an analgesic measure in chronic pain. Pain. 1979 Jun;6(3):335–347. doi: 10.1016/0304-3959(79)90052-6. [DOI] [PubMed] [Google Scholar]
  6. Foreman R. D. Viscerosomatic convergence onto spinal neurons responding to afferent fibers located in the inferior cardiac nerv. Brain Res. 1977 Nov 25;137(1):164–168. doi: 10.1016/0006-8993(77)91021-6. [DOI] [PubMed] [Google Scholar]
  7. González-Darder J. M., Canela P., González-Martinez V. High cervical spinal cord stimulation for unstable angina pectoris. Stereotact Funct Neurosurg. 1991;56(1):20–27. doi: 10.1159/000099389. [DOI] [PubMed] [Google Scholar]
  8. Hayano J., Sakakibara Y., Yamada M., Ohte N., Fujinami T., Yokoyama K., Watanabe Y., Takata K. Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity. Circulation. 1990 Apr;81(4):1217–1224. doi: 10.1161/01.cir.81.4.1217. [DOI] [PubMed] [Google Scholar]
  9. Kleiger R. E., Miller J. P., Bigger J. T., Jr, Moss A. J. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256–262. doi: 10.1016/0002-9149(87)90795-8. [DOI] [PubMed] [Google Scholar]
  10. Mannheimer C., Augustinsson L. E., Carlsson C. A., Manhem K., Wilhelmsson C. Epidural spinal electrical stimulation in severe angina pectoris. Br Heart J. 1988 Jan;59(1):56–61. doi: 10.1136/hrt.59.1.56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Mannheimer C., Carlsson C. A., Emanuelsson H., Vedin A., Waagstein F., Wilhelmsson C. The effects of transcutaneous electrical nerve stimulation in patients with severe angina pectoris. Circulation. 1985 Feb;71(2):308–316. doi: 10.1161/01.cir.71.2.308. [DOI] [PubMed] [Google Scholar]
  12. Meglio M., Cioni B., Rossi G. F., Sandric S., Santarelli P. Spinal cord stimulation affects the central mechanisms of regulation of heart rate. Appl Neurophysiol. 1986;49(3):139–146. doi: 10.1159/000100138. [DOI] [PubMed] [Google Scholar]
  13. Melzack R., Wall P. D. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971–979. doi: 10.1126/science.150.3699.971. [DOI] [PubMed] [Google Scholar]
  14. Murphy D. F., Giles K. E. Dorsal column stimulation for pain relief from intractable angina pectoris. Pain. 1987 Mar;28(3):365–368. doi: 10.1016/0304-3959(87)90070-4. [DOI] [PubMed] [Google Scholar]
  15. Nabel E. G., Barry J., Rocco M. B., Campbell S., Mead K., Fenton T., Orav E. J., Selwyn A. P. Variability of transient myocardial ischemia in ambulatory patients with coronary artery disease. Circulation. 1988 Jul;78(1):60–67. doi: 10.1161/01.cir.78.1.60. [DOI] [PubMed] [Google Scholar]
  16. Nademanee K., Intarachot V., Josephson M. A., Rieders D., Vaghaiwalla Mody F., Singh B. N. Prognostic significance of silent myocardial ischemia in patients with unstable angina. J Am Coll Cardiol. 1987 Jul;10(1):1–9. doi: 10.1016/s0735-1097(87)80152-3. [DOI] [PubMed] [Google Scholar]
  17. Quyyumi A. A., Panza J. A., Diodati J. G., Callahan T. S., Bonow R. O., Epstein S. E. Prognostic implications of myocardial ischemia during daily life in low risk patients with coronary artery disease. J Am Coll Cardiol. 1993 Mar 1;21(3):700–708. doi: 10.1016/0735-1097(93)90103-8. [DOI] [PubMed] [Google Scholar]
  18. Sanderson J. E., Brooksby P., Waterhouse D., Palmer R. B., Neubauer K. Epidural spinal electrical stimulation for severe angina: a study of its effects on symptoms, exercise tolerance and degree of ischaemia. Eur Heart J. 1992 May;13(5):628–633. doi: 10.1093/oxfordjournals.eurheartj.a060226. [DOI] [PubMed] [Google Scholar]
  19. Schang S. J., Jr, Pepine C. J. Transient asymptomatic S-T segment depression during daily activity. Am J Cardiol. 1977 Mar;39(3):396–402. doi: 10.1016/s0002-9149(77)80095-7. [DOI] [PubMed] [Google Scholar]
  20. Selwyn A. P., Allan R. M., L'Abbate A., Horlock P., Camici P., Clark J., O'Brien H. A., Grant P. M. Relation between regional myocardial uptake of rubidium-82 and perfusion: absolute reduction of cation uptake in ischemia. Am J Cardiol. 1982 Jul;50(1):112–121. doi: 10.1016/0002-9149(82)90016-9. [DOI] [PubMed] [Google Scholar]
  21. Shealy C. N., Mortimer J. T., Reswick J. B. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967 Jul-Aug;46(4):489–491. [PubMed] [Google Scholar]
  22. Stern S., Tzivoni D. Dynamic changes in the ST-T segment during sleep in ischemic heart disease. Am J Cardiol. 1973 Jul;32(1):17–20. doi: 10.1016/s0002-9149(73)80081-5. [DOI] [PubMed] [Google Scholar]
  23. Stern S., Tzivoni D., Stern Z. Diagnostic accuracy of ambulatory ECG monitoring in ischemic heart disease. Circulation. 1975 Dec;52(6):1045–1049. doi: 10.1161/01.cir.52.6.1045. [DOI] [PubMed] [Google Scholar]
  24. Tayler D. I., Vincent R. Artefactual ST segment abnormalities due to electrocardiograph design. Br Heart J. 1985 Aug;54(2):121–128. doi: 10.1136/hrt.54.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Tzivoni D., Gavish A., Benhorin J., Banai S., Keren A., Stern S. Day-to-day variability of myocardial ischemic episodes in coronary artery disease. Am J Cardiol. 1987 Nov 1;60(13):1003–1005. doi: 10.1016/0002-9149(87)90341-9. [DOI] [PubMed] [Google Scholar]
  26. UEDA H., SHIMOMURA K., GOTO H., YASUDA H., ITO K., KATAYAMA S., KUROIWA A., SUGIMOTO T. CHANGES IN CORONARY BLOOD FLOW BY STIMULATION OF CENTRAL NERVOUS SYSTEM. Jpn Heart J. 1964 Jul;5:323–336. doi: 10.1536/ihj.5.323. [DOI] [PubMed] [Google Scholar]
  27. Wall P. D., Sweet W. H. Temporary abolition of pain in man. Science. 1967 Jan 6;155(3758):108–109. doi: 10.1126/science.155.3758.108. [DOI] [PubMed] [Google Scholar]

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