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Operative Neuromodulation pp 283–288Cite as

Neurostimulation for refractory angina pectoris

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Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 97/1))

Summary

Spinal cord stimulation (SCS) has been shown to be particularly useful, safe and effective treatment in the management of patients with refractory angina pectoris and those unsuitable for percutaneous or surgical revascularisation. Clinical and experimental research has shown that it decreases myocardial ischemia without masking the clinical symptoms of its imminent development. In addition to providing pain relief, neurostimulation has also been shown to improve microcirculatory blood flow and increase the myocardial threshold for ischaemia. The anti-ischaemic effects of SCS have been evaluated by: a) exercise testing, b) ambulatory electrocardiogram (ECG), and c) invasive measurements of lactate from coronary sinus blood samples. Patients have reported not only significantly fewer angina attacks but also decreased consumption of glyceryl trinitrate and improved quality of life. A number of mechanisms have been proposed including placebo effects, primary anti-nociceptive effects, involvement of endogenous opiates, anti-sympathetic nervous system effects, increases in coronary blood flow, and redistribution of myocardial blood flow.

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References

  1. Anderson C, Hole P, Oxhoj H (1994) Does pain relief with spinal cord stimulation for angina conceal myocardial infarction? Br Heart J 71: 413–418

    Google Scholar 

  2. Chandler MJ, Brennan TJ, Garrison DW, Kim KS, Schwartz PJ, Foreman RD (1993) A mechanism of cardiac pain suppression by spinal cord stimulation: implications for patients with angina pectoris. Eur Heart J 14: 96–105

    PubMed  CAS  Google Scholar 

  3. Collins P, Fox KN (1990) Pathophysiology of angina. Lancet 335: 94–96

    Article  PubMed  CAS  Google Scholar 

  4. Chauhan A, Mullins PA, Thuraisingham SI, Taylor G, Petch MC, Schofield PM (1994) Effect of transcutaneous electrical nerve stimulation on coronary blood flow. Circulation 89: 694–702

    PubMed  CAS  Google Scholar 

  5. Crea F, Pupita G, Galassi AR, el Tamimi H, Kaski JC, Davies GJ, Maseri A (1989) Effect of theophylline on myocardial ischaemia. Lancet 1: 683–686

    Article  PubMed  CAS  Google Scholar 

  6. Dejongste MJL, Hautvast RWM, Hillege JL, Lie KI (1994) Efficacy of spinal cord stimulation as adjuvant therapy for intractable angina pectoris. Working Group on Neurocardiology. J Am Coll Cardiol 23: 1592–1597

    Article  CAS  Google Scholar 

  7. de Jongste MJ, Haaksma J, Hautvast RW, Hillege HL, Meyler PW, Staal MJ, Sanderson JE, Lie KI (1994) Effects of spinal cord stimulation on myocardial ischaemia during daily life in patients with severe coronary artery disease. A prospective ambulatory electrocardiographic study. Br Heart J 71: 413–418

    PubMed  Google Scholar 

  8. Dejonste MJL, Hautvast RWM, Hillege H (1994) Efficacy of spinal cord stimulation as adjuvant therapy for intractable angina pectoris: a prospective, randomised, clinical study. J Am Coll Cardiol 23: 1592–1597

    Article  Google Scholar 

  9. De Landsheere C, Mannheimer C, Habets A, Guillaume M, Bourgeois I, Augustinsson LE, Eliasson T, Lamotte D, Kulbertus H, Rigo P (1992) Effect of spinal cord stimulation on regional myocardial perfusion assessed by positron emission tomography. Am J Cardiol 69: 1143–1149

    Article  PubMed  Google Scholar 

  10. Diedrichs H, Zobel C, Theissen P, Weber M, Koulousakis A, Schicha H, Schwinger RH (2005) Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation. Curr Control Trials Cardiovasc Med 19: 6–7

    Google Scholar 

  11. Eliasson T, Mannheimer C, Waagstein F, Andersson B, Bergh CH, Augustinsson LE, Hedner T, Larson G (1998) Myocardial turnover of endogenous opioids and calcitonin-gene related peptide in the human heart and the effects of spinal cord stimulation on pacing induced angina pectoris. Cardiology 89: 170–177

    Article  PubMed  CAS  Google Scholar 

  12. Emanuelsson H, Mannheimer C, Waagstein F, Wilhelmsson C (1987) Catecholamine metabolism during pacing induced angina pectoris and the effect of transcutaneous electrical nerve stimulation. Am Heart J 114: 1360–1366

    Article  PubMed  CAS  Google Scholar 

  13. Falcone C, Specchia G, Rondanelli R, Guasti L, Corsico G, Codega S, Montemartini C (1988) Correlation between beta-endorphin plasma levels and anginal symptoms in patients with coronary artery disease. J Am Coll Cardiol 11: 719–723

    Article  PubMed  CAS  Google Scholar 

  14. Ferguson RJ, Petitclerc R, Choquette G, Chaniotis L, Gauthier P, Huot R, Allard C, Jankowski L, Campeau L (1974) Effect of physical training on treadmill exercise capacity, collateral circulation and progression of coronary disease. Am J Cardiol 34: 764–769

    Article  PubMed  CAS  Google Scholar 

  15. Ganz P, Braunwald E (1997) Coronary blood flow and myocardial ischaemia. In: Braunwald E (ed) Heart disease, 5th edn. WB Saunders, Philadelphia, pp 1161–1163

    Google Scholar 

  16. Gaspardone A, Crea F, Iamele M, Tomai F, Versaci F, Pellegrino A, Chiariello L, Gioffre PA (1993) Bamiphylline improves exerciseinduced myocardial ischaemia through a novel mechanism of action. Circulation 88: 502–508

    PubMed  CAS  Google Scholar 

  17. Greco S, Auriti A, Fiume D, Gazzeri G, Gentilucci G, Antonini L, Santini M (1999) Spinal cord stimulation for the treatment of refractory angina pectoris: a two-year follow-up. Pacing Clin Electrphysiol 22: 26–32

    Article  CAS  Google Scholar 

  18. Hautvast RW, DeJongste MJ, Staal MJ, van Gilst WH, Lie KI (1998) Spinal cord stimulation intractable angina pectoris: A randomized, controlled efficacy study. Am Heart 136: 1114–1120

    Article  CAS  Google Scholar 

  19. Hautvast RW, Blanksma PK, DeJongste MJ, Pruim J, van der Wall EE, Vaalburg W, Lie KI (1996) Effect of spinal cord stimulation on myocardial blood flow; assessed by positron, emission tomography in patients with refractory angina pectoris. Am J Cardiol 77: 462–467

    Article  PubMed  CAS  Google Scholar 

  20. Jacobs MJ, Jorning PJ, Joshi SR, Kitslaar PJ, Slaaf DW, Reneman RS (1988) Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischaemia. Ann Surg 207: 170–183

    Article  Google Scholar 

  21. Jessurun GA, DeJongste MJ, Blanksma PK (1996) Current view on neurostimulation in treatment of cardiac syndrome. Pain 65: 109–116

    Article  Google Scholar 

  22. Jessurun GA, Tio RA, De Jongste MJ, Hautvast RW, Den Heijer P, Crijns HJ (1998) Coronary blood flow dynamics during transcutaneous electrical nerves stimulation for stable angina pectoris associated with severe narrowing of one major coronary arteries. Am J Cardiol 82: 921–926

    Article  PubMed  CAS  Google Scholar 

  23. Jessurun GA, Ten Vaarwerk IA, DeJongste MJ, Tio RA, Staal MJ (1998) Sequelae of spinal cord stimulation for refractory angina pectoris. Reliability and safety profie of long-term clinical application. Coron Atery Dis 8: 33–38

    Article  Google Scholar 

  24. Kaada B (1982) Vasodilatation induced by transcutaenous nerve stimulation in peripheral ischaemia. Eur Heart J 3: 303–306

    PubMed  CAS  Google Scholar 

  25. Khurmi NS, Bowles MJ, Kohli RS, Raftery EB (1986) Does placebo improve indexes of effort-induced myocardial ischaemia? An objective study in 150 patients with chronic stable angine pectoris. Am J Cardiol 57: 907–911

    Article  PubMed  CAS  Google Scholar 

  26. Kujacic V, Eliasson T, Mannheimer C, Jablonskiene D, Augustinsson LE, Emanuelsson H (1993) Assessment of spinal cord stimulation (SCS) on left ventricular function in patients with severe angina pectoris: an echocardiographic study. Eur Heart J 14: 1238–1244

    PubMed  CAS  Google Scholar 

  27. Lasagna L, Mosteller F, Felsinger J, Beecher HK (1954) A study of the placebo response. Am J Med 16: 770–779

    Article  PubMed  CAS  Google Scholar 

  28. Metzack R, Wall PD (1965) Pain mechanisms. Science 150: 971–979

    Article  Google Scholar 

  29. Mannheimer C, Carlsson CA, Ericson K, Vedin A, Wilhelmsson C (1982) Transcutaneous electrical nerve stimulation in severe angina pectoris. Eur Heart J 3: 297–302

    PubMed  CAS  Google Scholar 

  30. Mannheimer C, Carlsson CA, Emanuelsson H, Vedin A, Waagstein F, Wilhelmsson C (1985) The effects of transcutaneous electrical nerve stimulation in patients with severe angina pectoris. Circulation 71: 308–316

    PubMed  CAS  Google Scholar 

  31. Mannheimer C, Augustinsson LE, Carlsson CA, Manhem K, Wilhelmsson C (1988) Epidural spinal electrical stimulation in severe angina pectoris. Br Heart J 59: 56–61

    PubMed  CAS  Google Scholar 

  32. Mannheimer C, Eliasson T, Andersson B, Bergh CH, Augustinsson LE, Emanuelsson H, Waagstein F (1993) Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action. BMJ 307: 477–480

    Article  PubMed  CAS  Google Scholar 

  33. Mannheimer C, Emanuelsson H, Waagstein F, Wilhelmsson C (1989) Influence of naloxone on the effects of transcutaneous electrical nerve stimulation (TENS) in angina pectoris induced by pacing induced. Br Heart J 62: 36–42

    PubMed  CAS  Google Scholar 

  34. Mannheimer C, Eliasson T, Augustinsson LE, Blomstrand C, Emanuelsson H, Larsson S, Norrsell H, Hjalmarsson A (1998) Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris. The ESBY Study. Circulation 97: 1157–1163

    PubMed  CAS  Google Scholar 

  35. Moore R, Chester M (2001) Neuromodulation for chronic refractory angina. Br Med Bull 59: 269–278

    Article  PubMed  CAS  Google Scholar 

  36. Murray S, Collins PD, James MA (2000) Neurostimulation. Treatment for angina pectoris. Heart 83: 217–220

    Article  PubMed  CAS  Google Scholar 

  37. Murphy DF, Giles KE (1987) Dorsal column stimulation for pain relief from intractable angina pectoris. Pain 28: 365–368

    Article  PubMed  CAS  Google Scholar 

  38. Murray S, Carson KG, Ewings PD, Collins PD, James MA (1999) Spinal cord stimulation (SCS) significantly decreases the need for acute hospitalisation due to chest pain in patients with refractory angina pectoris. Heart 82: 89–92

    PubMed  CAS  Google Scholar 

  39. Norrsell H, Eliasson T, Mannheimer C, Augustinsson LE, Bergh CH, Andersson B, Waagstein F, Friberg P (1997) Effects of pacing induced myocardial stress and spinal cord stimulation on whole body and cardiac norepinephrine spillover. Eur Heart J 18: 1890–1896

    PubMed  CAS  Google Scholar 

  40. Sanderson JE, Tomlinson B, Lau MS, So KW, Cheung AH, Critchley JA, Woo KS (1995) The effects of transcutaneous nerve stimulation (TENS) on the autonomic cardiovascular reflexes. Clin Auton Res 5: 81–84

    Article  PubMed  CAS  Google Scholar 

  41. Sanderson JE, Brooksby P, Waterhouse D, Palmer RB, Neubauer K (1992) Epidural spinal electrical stimulation for severe angina: a study of its effect on symptoms, exercise tolerance and degree of ischaemia. Eur Heart J 13: 628–633

    PubMed  CAS  Google Scholar 

  42. Sanderson JE, Ibrahim B, Waterhouse D, Palmer RB (1994) Spinal electrical stimulation for intractable angina — long term clinical outcome and safety. Eur Heart J 15: 810–814

    PubMed  CAS  Google Scholar 

  43. Sanderson JE, Woo KS, Chung HK, Chan WW, Tse LK, White HD (1996) The effect of transcutaneous electrical nerve stimulation on coronary and systemic haemodynamics in syndrome X. Coron Artery Dis 7: 547–552

    Article  PubMed  CAS  Google Scholar 

  44. Schofield PM, Sharples LD, Caine N, Burns S, Tait S, Wistow T, Buxton M, Wallwork J (1999) Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial. Lancet 353: 519–524

    Article  PubMed  CAS  Google Scholar 

  45. Segal R, Murali S, Tipton K (1996) Treatment of chronic unstable angina pectoris: use of a totally implantable programmable device for continuous intrathecal infusion of opiates: case report. Neurosurgery 38: 385–388

    Article  PubMed  CAS  Google Scholar 

  46. Seilar C, Kaufmann U, Meier B (1997) Intracoronary demonstration of adenosine induced coronary collateral steal. Heart 77: 78–81

    Google Scholar 

  47. Shealey CN, Mortimer JT, Reswick JB (1967) Electrical inhibition of pain by stimulation of the dorsal columns. Anesth Analg 46: 45–47

    Google Scholar 

  48. The Criteria Committee of the New York Heart Association (1994) Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels (9th ed). Boston, Mass: Little, Brown & Co., pp 253–256

    Google Scholar 

  49. Wall P (1992) The placebo effect: an unpopular topic. Pain 51: 1–3

    Article  PubMed  CAS  Google Scholar 

  50. Wettervik C, Claes G, Drott C, Emanuelsson H, Lomsky M, Radberg G, Tygesen H (1995) Endoscopic transthoracic sympathectomy for severe angina. Lancet 345: 97–98

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Neurosurgery, Riyadh Armed Forces Hospital, PO Box 7897, Riyadh, 11159, Saudi Arabia

    Sohail Ansari, K. Chaudhri & K. Moutaery

Authors
  1. Sohail Ansari
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  2. K. Chaudhri
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  3. K. Moutaery
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Correspondence to Sohail Ansari .

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Editors and Affiliations

  1. Department of Neurosurgery, University of Athens, Athens, Greece

    Damianos E. Sakas

  2. University Hospital of Wales, Cardiff, UK

    Brian A. Simpson

  3. Pacific Pain Treatment Centers, San Francisco, USA

    Elliot S. Krames

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© 2007 Springer-Verlag

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Ansari, S., Chaudhri, K., Moutaery, K. (2007). Neurostimulation for refractory angina pectoris. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_38

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  • DOI: https://doi.org/10.1007/978-3-211-33079-1_38

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-33078-4

  • Online ISBN: 978-3-211-33079-1

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