Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1993 Aug 21;307(6902):477-80.
doi: 10.1136/bmj.307.6902.477.

Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action

C Mannheimer  1 , T Eliasson, B Andersson, C H Bergh, L E Augustinsson, H Emanuelsson, F Waagstein
Affiliations

Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action

C Mannheimer et al. BMJ. .

Abstract

Objective: To investigate the effects of spinal cord stimulation on myocardial ischaemia, coronary blood flow, and myocardial oxygen consumption in angina pectoris induced by atrial pacing.

Design: The heart was paced to angina during a control phase and treatment with spinal cord stimulation. Blood samples were drawn from a peripheral artery and the coronary sinus.

Setting: Multidisciplinary pain centre, department of medicine, Ostra Hospital, and Wallenberg Research Laboratory, Sahlgrenska Hospital, Gothenburg, Sweden.

Subjects: Twenty patients with intractable angina pectoris, all with a spinal cord stimulator implanted before the study.

Results: Spinal cord stimulation increased patients' tolerance to pacing (p < 0.001). At the pacing rate comparable to that producing angina during the control recording, myocardial lactate production during control session turned into extraction (p = 0.003) and, on the electrocardiogram, ST segment depression decreased, time to ST depression increased, and time to recovery from ST depression decreased (p = 0.01; p < 0.05, and p < 0.05, respectively). Spinal cord stimulation also reduced coronary sinus blood flow (p = 0.01) and myocardial oxygen consumption (p = 0.02). At the maximum pacing rate during treatment, all patients experienced anginal pain. Myocardial lactate extraction reverted to production (p < 0.01) and the magnitude and duration of ST segment depression increased to the same values as during control pacing, indicating that myocardial ischaemia during treatment with spinal cord stimulation gives rise to anginal pain.

Conclusions: Spinal cord stimulation has an anti-anginal and anti-ischaemic effect in severe coronary artery disease. These effects seem to be secondary to a decrease in myocardial oxygen consumption. Furthermore, myocardial ischemia during treatment gives rise to anginal pain. Thus, spinal cord stimulation does not deprive the patient of a warning signal.

PubMed Disclaimer

Comment in

References

    1. Br Heart J. 1977 Aug;39(8):829-33 - PubMed
    1. Circulation. 1979 Nov;60(5):1036-44 - PubMed
    1. Circ Res. 1979 Dec;45(6):708-18 - PubMed
    1. Circulation. 1980 Feb;61(2):256-61 - PubMed
    1. Appl Neurophysiol. 1982;45(1-2):201-4 - PubMed