Neurostimulation for the treatment of refractory angina pectoris
Authors:
P. Neužil 1; D. Urgošík 2; M. Táborský 1
Authors‘ workplace:
Kardiologické oddělení Kardiocentra
Primář: doc. MUDr. Miloš Táborský, CSc., FESC, MBA
1; Oddělení stereotaktické a radiační neurochirurgie Neurocentra
Primář: doc. MUDr. Roman Liščák, CSc.
Nemocnice Na Homolce
Ředitel: MUDr. Vladimír Dbalý, MBA
2
Published in:
Prakt. Lék. 2009; 89(2): 85-88
Category:
Of different specialties
Overview
Background:
Neurostimulation as a symptomatic treatment of refractory angina pectoris (AP) is one of only a few methods (along with laser revascularization) that can be used to improve the quality of life of patients with this debilitating disease. Patients with advanced stages of AP (III-IV. CCSC classification) are indicated for this treatment when neither open-heart surgery nor percutaneous revascularization (PCI) improves the symptoms in concert with maximal drug treatment.
Method:
In this review we describe the method of spinal cord stimulation (SCS), covering the experience with this method in the Czech Republic as well as abroad. This treatment is concentrated in pain syndrome treatment centres and is notable for its interdisciplinary cooperation. The procedure itself is carried out by an anaesthetist or neurosurgeon with the assistance of a cardiologist who is also responsible for the follow-up care using a programme which allows communication with and programming of the neurostimulator device that is implanted into the patient. The other part of the review discusses the mechanisms of the positive influence of stimulation including a potential placebo effect, b endorphins stimulation, decrease of nociceptive inputs, „homogenization“ of the myocardial perfusion, decrease of the effect of adenosine; nevertheless the basic concept is based on direct stimulation of low-threshold A fibres, which conduct pain-less impulses. SCS attenuates sensitivity of high-threshold thin C fibres, which are responsible for conducting the painful impulse through the spino-thalamic pathway, which is diminished by the effect of SCS.
Conclusion:
Our own experience and results published in the international literature clearly document, in a highly selected patient group, that this symptomatic treatment, particularly for very active individuals, helps to relieve attacks of pain and improves patient quality of life.
Key words:
Refractory angina pectoris, neuromodulation, spinal cord stimulation
Sources
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General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2009 Issue 2
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