Spinal-cord stimulation relieves angina pain in those unsuited for coronary bypass April 17, 1997 By Jason Kahn c. 1997 Medical Tribune ANAHEIM, Calif.-A method of sending an electrical current into the spine may relieve angina pain and provide an alternative to coronary artery bypass graft surgery in those patients with a poor prognosis from the operation, researchers reported here last month at the annual meeting of the American College of Cardiology. Swedish researchers used spinal- cord stimulation-in which a tiny electrode is implanted between two vertebrae of the neck and attached to the membrane covering the spinal cord-to treat 54 angina patients, comparing them with 51 who received standard bypass surgery. To regulate the intensity of the current reaching the spinal cord, a small, battery-powered generator is placed under the skin just below the ribs. In the study, both groups experienced significant and equal rates of pain relief after six months, according to lead researcher Clas Mannheimer, M.D., of Ostra University Hospital in G teborg, Sweden. There were eight deaths during follow-up, all from myocardial infarction, though only one in the spinal- stimulation group. Cerebrovascular morbidity also was lower in the spinal-stimulation group. The CABG group had an increase in exercise capacity and less ST-segment depression on maximum and comparable work loads. The anti-ischemic effects of CABG seemed to be limited to patients with an ejection fraction greater than or equal to median. The new treatment may somehow reduce the amount of oxygen needed by the heart, as Beta-blockers do, and thereby help alleviate both the cause of the angina and the resulting pain, the researchers speculated. "We think that it activates the neural structures affecting the heart, but we're not exactly sure," said study coauthor Tore Eliasson, M.D., Ph.D., a cardiologist from the Multidisciplinary Pain Center in Ostra, Sweden. He explained that the stimulator can be turned on and off by a small magnet controlled by the patient. "They feel a little tickling in the area of pain, and pain relief occurs within a minute," Dr. Eliasson said. The device operates at two settings-a low, constant current to prevent angina symptoms, and a higher one to ward off an attack. Dr. Eliasson stressed that spinal- cord stimulation is meant for angina patients with severe heart disease who have no other options and who are not good candidates for bypass surgery. In the study, the majority of the patients had blockages in all three coronary arteries and were deemed to be at high risk of death or complications from surgery. "The idea makes sense," said Daniel Schindler, M.D., a cardiologist at the Robert Wood Johnson Medical School in New Brunswick, N.J. "There is a subset of people who are hurting constantly. I definitely think this deserves to be an option." Gerald Lawrie, M.D., a thoracic surgeon at the Baylor College of Medicine in Houston, noted that bypass surgery is effective for most angina patients, but that in those with severe heart disease, the operation carries with it significant risks. "It's a very interesting idea," he said. "I'd like to see the mortality rates about five years down the road, but there may be a place for this in some patients." Dr. Eliasson noted that many U.S. medical centers have expressed interest in offering spinal- cord stimulation to patients once approval is granted by the Food and Drug Administration. The Swedish cardiologist said he expects the procedure to be presented to the FDA for review in the near future. "It's applicable to most hospitals," he said. "It does not demand a great deal of resources, just a neurosurgeon to put it in."
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