Anesth Pain Med.  2023 Jul;18(3):302-306. 10.17085/apm.23020.

Burst stimulation for refractory angina pectoris - A case report -

• Yun D
• Lee K
• Kwak JS
• Je L
• Kim T
• Park YS
• Koh JC

• KMID: 2547040
• DOI: http://doi.org/10.17085/apm.23020

Abstract

Background
Refractory angina pectoris (RAP) is a chronic, severe chest pain associated with coronary artery disease that cannot be resolved using optimal medical or surgical approaches. Spinal cord stimulation (SCS) is a suitable treatment option. Conventional waveforms of SCS have shown a potent effect on the tempering of RAP. However, SCS is associated with undesired paresthesia. The new burst SCS waveforms have been reported to have fewer adverse effects. Case: We reviewed a case in which RAP was successfully treated with burst SCS in a middle-aged male, with a tonic waveform employed for breakthrough pain as needed.
Conclusions
Appropriate use of tonic and burst stimulations according to the symptoms is expected to maximize the effect of relieving chest pain induced by RAP.

Keyword

Angina pectoris; Breakthrough pain; Burst stimulation; Chest pain; Coronary artery disease; Spinal cord stimulation

Figure

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  Fig. 1. Chest radiographs showing the tip of the electrode lead located in the thoracic vertebra 1–2 epidural space and slightly to the left (anteroposterior view).

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  Fig. 2. A permanent pulse generator is implanted subcutaneously in the lower quadrant of the patient’s abdomen (lateral view).

Reference

1. Mannheimer C, Eliasson T, Augustinsson L-E, Blomstrand C, Emanuelsson Hk, Larsson S, et al. Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation. 1998; 97:1157–63.

2. McNab D, Khan SN, Sharples LD, Ryan JY, Freeman C, Caine N, et al. An open label, single-centre, randomized trial of spinal cord stimulation vs. percutaneous myocardial laser revascularization in patients with refractory angina pectoris: the SPiRiT trial. Eur Heart J. 2006; 27:1048–53.

3. Murphy DF, Giles KE. Dorsal column stimulation for pain relief from intractable angina pectoris. Pain. 1987; 28:365–8.

4. De Ridder D, Vanneste S, Plazier M, Van der Loo E, Menovsky T. Burst spinal cord stimulation: toward paresthesia-free pain suppression. Neurosurgery. 2010; 66:986–90.

5. Abusabha Y, Slotty PJ. Successful burst spinal cord stimulation in refractory angina. Neuromodulation. 2019; 22:229–30.

6. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013; 109:5–12.

7. Guan Y. Spinal cord stimulation: neurophysiological and neurochemical mechanisms of action. Curr Pain Headache Rep. 2012; 16:217–25.

8. Foreman RD, Linderoth B. Neural mechanisms of spinal cord stimulation. Int Rev Neurobiol. 2012; 107:87–119.

9. Chakravarthy K, Fishman MA, Zuidema X, Hunter CW, Levy R. Mechanism of action in burst spinal cord stimulation: review and recent advances. Pain Med. 2019; 20(Suppl 1):S13–S22.

10. Hou S, Kemp K, Grabois M. A systematic evaluation of burst spinal cord stimulation for chronic back and limb pain. Neuromodulation. 2016; 19:398–405.

11. Latif OA, Nedeukovic SS, Stevenson LW. Spinal cord stimulation for chronic intractable angina pectoris: a unified theory on its mechanism. Clin Cardiol. 2001; 24:533–41.

12. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012; 126:e354–e471.

13. Lee SH, Jeong HJ, Jeong SH, Lee HG, Choi JI, Yoon MH, et al. Spinal cord stimulation for refractory angina pectoris -a case report-. Korean J Pain. 2012; 25:121–5.

14. de Vos CC, Bom MJ, Vanneste S, Lenders MW, De Ridder D. Burst spinal cord stimulation evaluated in patients with failed back surgery syndrome and painful diabetic neuropathy. Neuromodulation. 2014; 17:152–9.