Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Spinal electrical stimulation for intractable angina—long-term clinical outcome and safety
Departments of Cardiology Musgrove Park, Taunton, Somerset TA1 5DA, U.K.
*Anaesthesia, Taunton and Somerset Hospital Musgrove Park, Taunton, Somerset TA1 5DA, U.K.
Received 19 July 1993; revised 4 January 1994; .
Correspondence: Dr John Sanderson, Cardiac Unit, Department of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, Hong Kong.
Abstract
Spinal cord electrical stimulation is an alternative therapy for patients with chronic pain syndromes including angina. Although it has been shown to produce symptomatic relief and reduce ischaemia, doubts remain about its long-term safety. We report here for the first time the results of a follow-up study over a period of 62 months, mean 45 months (range 21–62), of 23 patients who had stimulator units implanted for intractable angina unresponsive to standard therapy. Symptomatic improvement was good and persisted in the majority with a mean (SD) change of NYHA grade from 3.1 (0.8) pre-operatively to 2.0 (0.9) (P<0.01) immediately after operation and 2.1 (1.07) at the latest follow-up. GTN consumption fell markedly. Mean (SEM) treadmill exercise time increased from 407 (45) s with the stimulator off to 499 (46) s with the stimulator on (P<0.01). Forty-eight hour ST segment monitoring in those with bipolar leads showed a reduction of total number and duration of ischaemic episodes. There were three deaths, none of which were sudden or unexplained and this mortality rate is acceptable for such a group of patients. Two patients had a myocardial infarction, which was associated with typical pain and not masked by the treatment. Complications related to earlier lead designs were frequent.
This study confirms that spinal electrical stimulation is an effective and safe form of alternative therapy for the occasional patient whose angina is unresponsive to standard therapies.
Key Words: Angina • Spinal electrical stimulation • safety • clinical outcome
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