Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

Lanza, Gaetano Antonio; Barone, Lucy; Monaco, Antonio Di

doi:10.1111/j.1525-1403.2012.00430.x

Cited by 22 publications

(16 citation statements)

References 53 publications

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“…and provides effective pain relieve in 70% of patients who suffer refractory angina due to severe coronary artery disease. 10,11,23,24 In addition to modulation of the nociceptive influx associated with myocardial ischemia, 25,26 it has been proposed that SCS can restore the balance between myocardial oxygen supply and demand during ischemia. 27 In addition, SCS applied at the C 7 -C 8 and/or T 1 -T 6 level can modulate the reflex activation of the parasympathetic and sympathetic nervous system.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Spinal Cord Stimulation for Heart Failure as a Restorative Treatment (SCS HEART study): First-in-man experience

Tse¹,

Turner²,

Sanders³

et al. 2015

Heart Rhythm

102

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Section: Discussionmentioning

confidence: 99%

Thoracic Spinal Cord Stimulation for Heart Failure as a Restorative Treatment (SCS HEART study): First-in-man experience

Tse¹,

Turner²,

Sanders³

et al. 2015

Heart Rhythm

102

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“…Spinal cord stimulation (SCS) is an adjustable, reversible, and nondestructive treatment for a variety of chronic pain syndromes. Its efficacy has been proven in multiple randomized controlled trials for failed back surgery syndrome (FBSS) (1-7), complex regional pain syndrome (CRPS) (3,6,8,9), refractory angina pectoralis (10)(11)(12), painful diabetic neuropathy (13), and peripheral vascular disease (14). SCS has also been shown to be cost-effective for FBSS, CRPS, and refractory angina pectoralis when compared with conventional medical therapy alone (5,7,9,(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Spinal Cord Injury in Implantation of Percutaneous and Paddle Electrodes for Spinal Cord Stimulation

Petraglia

Farber

Gramer

et al. 2016

Neuromodulation: Technology at the Neural Interface

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Objective Spinal cord stimulation (SCS) has been proven effective for multiple chronic pain syndromes. Over the past 40 years of use, the complication rates of SCS have been well defined in the literature; however, the incidence of one of the most devastating complications, spinal cord injury (SCI), remains largely unknown. The goal of the study was to quantify the incidence of SCI in both percutaneous and paddle electrode implantation. Methods We conducted a retrospective review of the Thomson Reuter's MarketScan database of all patients that underwent percutaneous or paddle SCS implantation from 2000 to 2009. The main outcome measures of the study were the incidence of SCI and spinal hematoma within 30 days following operation. Results Overall 8,326 patients met inclusion criteria for the study (percutaneous 5,458 vs. paddle: 2,868). The overall incidence of SCI was 177 (2.13%) (percutaneous: 128 (2.35%) vs. paddle: 49 (1.71%), p=0.0556). The overall incidence of spinal hematoma was 59 (0.71%) (percutaneous: 41 (0.75%) vs. paddle: 18 (0.63%), p = 0.5230). Conclusion Our study shows the overall incidence of SCI in SCS is low (2.13%) supporting that SCS is a safe procedure. No significant difference was found in the rates of SCI or spinal hematoma between the percutaneous and paddle groups. Further studies are needed to characterize the mechanisms of SCI in SCS and long-term outcomes in these patients.

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“…Large trials are lacking in this field; however, most studies indicate that the procedure is safe, with device-related infections and catheter dislodgements as the most common complications of the procedure. 51 There was concern in the angina trials that SCS may mask a true MI; however, evaluation of patients with electrocardiogram (ECG) evidence of an MI occurring after implantation of the spinal cord stimulator demonstrated that they were aware when their MI occurred. 66 Therefore, use of SCS for either heart failure treatment or possibly for arrhythmia control is unlikely to mask significant ischaemic pain.…”

Section: Potential Adverse Effects Of Spinal Cord Stimulationmentioning

confidence: 99%

“…51 The precise mechanism underlying its beneficial effect in angina is debated; however, experimental studies suggest that spinal cord stimulation likely modulates preganglionic sympathetic input to the intrinsic cardiac nervous system, decreases afferent sensory output from intrinsic cardiac nerves during ischaemia, and stabilises the activity of the intrinsic cardiac nervous system during an ischaemic challenge. 3,4,52,53 SCS may have an antiarrhythmic role as well.…”

Section: Spinal Cord Stimulation Spinal Cord Stimulation and Atrial Ementioning

confidence: 99%

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

Hucker

Singh

Parks

et al. 2014

Arrhythm Electrophysiol Rev

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The interplay between the central nervous system and cardiac electrophysiology is fundamental, and becomes obvious each time one's pulse quickens in response to stress. Normally, cardiac neurohormonal regulation is accomplished through the balanced effects of sympathetic and parasympathetic autonomic stimulation, along with the hormonal regulation of the renin-angiotensinaldosterone system (RAAS). Autonomic and hormonal input modulate multiple facets of cellular electrophysiology -action potential duration, ion channel kinetics and intracellular calcium dynamics (just to name a few) -which translate into macroscopic manifestations of autonomic modulation such as heart rate variability, atrioventricular (AV) conduction time and QT interval variability.1 Therefore, it is no surprise that neurohormonal regulation of cardiac electrophysiology is an area of active investigation for its potential antiarrhythmic effects. Recent reviews have focused on the efficacy of neurohormonal modulation, via non-pharmacological methods, to enhance heart failure treatment. 2,3 This review will attempt to provide a state-of-the-art on the potential antiarrhythmic efficacy of renal artery denervation, spinal cord stimulation and direct vagal stimulation. Neurohormonal Control in the Normal and Failing HeartAutonomic control of cardiac physiology is often conceptualised as parasympathetic (cholinergic) and sympathetic (adrenergic) innervation existing in a 'yin and yang' balance under normal circumstances; however, this concept may be over-simplified. 4 In reality, the intrinsic cardiac nervous system, composed of several ganglia located primarily posterior to the atria, likely acts as a 'little brain' of the heart -it provides efferent input to the myocardium, collects afferent signals on a beat-to-beat basis and performs some integrative functions on its own, all under the tonic modulation of extrinsic sympathetic and parasympathetic input (see Figure 1). 4-8The ganglia are predominantly composed of cholinergic neurons; however, sympathetic efferent neurons are also present. Due to the complex interconnectivity between the ganglia, afferent mechanosensory, nociceptive and chemosensory signals from all four chambers of the heart may be processed within a single ganglion. 4 Such interconnectivity implies that predicting the effect of stimulation or ablation of a particular ganglion may be difficult, because each ganglion performs multiple functions. 7,9Abstract Alterations in resting autonomic tone can be pathogenic in many cardiovascular disease states, such as heart failure and hypertension.Indeed, autonomic modulation by way of beta-blockade is a standard treatment of these conditions. There is a significant interest in developing non-pharmacological methods of autonomic modulation as well. For instance, clinical trials of vagal stimulation and spinal cord stimulation in the treatment of heart failure are currently underway, and renal denervation has been studied recently in the treatment of resistant hypertension. Notably, autonom...

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Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies

Cited by 22 publications

References 53 publications

Thoracic Spinal Cord Stimulation for Heart Failure as a Restorative Treatment (SCS HEART study): First-in-man experience

Thoracic Spinal Cord Stimulation for Heart Failure as a Restorative Treatment (SCS HEART study): First-in-man experience

The Incidence of Spinal Cord Injury in Implantation of Percutaneous and Paddle Electrodes for Spinal Cord Stimulation

Device-Based Approaches to Modulate the Autonomic Nervous System and Cardiac Electrophysiology

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