Spinal cord stimulation for refractory stable angina pectoris in patients with chronic pacemaker treatment

Abstract

Spinal cord stimulation (SCS) is a safe treatment modality in patients with severe angina pectoris. We studied possible interactions of procedures in patients treated with both, SCS for angina pectoris and permanent pacemaker (PPM) treatment for bradyarrhythmias. Methods used Since January 2001, we performed SCS in 61 patients (pts.) (48 men, 13 women, age 65±8 years, bmi 27±9 kg/qm). Nine pts. additionally needed PPM treatment for bradyarrhythmias. All pts. had severe angina pectoris (III to IV [39/22] according to Canadian Cardiovascular Society) under considered medication due to angiographically documented end-stage coronary artery disease (CAD), which could not be treated interventionally. After 3 to 5 days of successful test stimulation using an epidural lead a commercially available implantable pulse generator is placed in a subcutaneous pouch below the costal arch. Results In 58 pts. (95%) angina pectoris could be reduced significantly. In 3 pts. the lead was removed because of ineffectivity during the test period. There was no interaction between neurostimulation and PPM treatment during follow-up of 1 to 38 (mean 20±12) months. DDD pacemaker were used in bipolar sensing mode: n=4 Medtronic, n=3 Biotronik, n=2 Guidant. View this table: Conclusion SCS has proved to be a safe procedure in patients with severe angina pectoris and PPM treatment with bipolar sensing mode.