2006 Heart-Brain summit proceedings
The anti-ischemic effects of electrical neurostimulation in the heart
ARTICLE INTRODUCTION
In 2001, the American College of Cardiology and the American Heart Association introduced electrical neurostimulation (ENS) in their joint guidelines for the treatment of angina pectoris. The introduction of this therapy was supported by many (mainly small) articles examining the beneficial effects of ENS for patients with treatment-refractory angina. Even though ENS is considered to be an antianginal therapy, many physicians question the anti-ischemic benefit that ENS is frequently suggested to confer. This review briefly summarizes the antianginal effects of ENS, with a focus on the therapy’s anti-ischemic outcomes.
CITATIONS
- Benson CJ, Eckert SP, McCleskey EW.
Acid-evoked currents in cardiac sensory neurons: a possible mediator of myocardial ischemic sensation. Circ Res 1999; 84:921–928.
http://www.ncbi.nlm.nih.gov/pubmed/10222339 - Longhurst JC, Tjen ALS, Fu LW.
Cardiac sympathetic afferent activation provoked by myocardial ischemia and reperfusion. Mechanisms and reflexes. Ann N Y Acad Sci 2001; 940:74–95.
http://www.ncbi.nlm.nih.gov/pubmed/11458709 - Foreman RD.
Mechanisms of cardiac pain. Annu Rev Physiol 1999; 61:143–167.
http://www.ncbi.nlm.nih.gov/pubmed/10099685 - Crea F, Gaspardone A, Kaski JC, Davies G, Maseri A.
Relation between stimulation site of cardiac afferent nerves by adenosine and distribution of cardiac pain: results of a study in patients with stable angina. J Am Coll Cardiol 1992; 20:1498–1502.
http://www.ncbi.nlm.nih.gov/pubmed/1452922 - Gaspardone A, Crea F, Tomai F, et al.
Muscular and cardiac adenosine- induced pain is mediated by A1 receptors. J Am Coll Cardiol 1995; 25:251–257.
http://www.ncbi.nlm.nih.gov/pubmed/7798511 - De Jongste MJ, Haaksma J, Hautvast RW, et al.
Effects of spinal cord stimulation on myocardial ischaemia during daily life in patients with severe coronary artery disease. A prospective ambulatory electrocardiographic study. Br Heart J 1994; 71:413–418.
http://www.ncbi.nlm.nih.gov/pubmed/8011403 - Mannheimer C, Camici P, Chester MR, et al.
The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J 2002; 23:355–370.
http://www.ncbi.nlm.nih.gov/pubmed/11846493 - Braunwald E, Epstein SE, Glick G, Wechsler AS, Braunwald NS.
Relief of angina pectoris by electrical stimulation of the carotidsinus nerves. N Engl J Med 1967; 277:1278–1283.
http://www.ncbi.nlm.nih.gov/pubmed/5299662 - Mannheimer C, Carlsson CA, Ericson K, Vedin A, Wilhelmsson C.
Transcutaneous electrical nerve stimulation in severe angina pectoris. Eur Heart J 1982; 3:297–302.
http://www.ncbi.nlm.nih.gov/pubmed/6982163 - Murphy DF, Giles KE.
Dorsal column stimulation for pain relief from intractable angina pectoris. Pain 1987; 28:365–368.
http://www.ncbi.nlm.nih.gov/pubmed/3494978 - Hautvast RW, Ter Horst GJ, DeJong BM, et al.
Relative changes in regional cerebral blood flow during spinal cord stimulation in patients with refractory angina pectoris. Eur J Neurosci 1997; 9:1178–1183.
http://www.ncbi.nlm.nih.gov/pubmed/9215701 - Nademanee K, Christenson PD, Intarachot V, Robertson HA, Mody FV.
Variability of indexes for myocardial ischemia: a comparison of exercise treadmill test, ambulatory electrocardiographic monitoring and symptoms of myocardial ischemia. J Am Coll Cardiol 1989; 13:574–579.
http://www.ncbi.nlm.nih.gov/pubmed/2493043 - Borzak S, Fenton T, Glasser SP, et al.
Discordance between effects of anti-ischemic therapy on ambulatory ischemia, exercise performance and anginal symptoms in patients with stable angina pectoris. The Angina and Silent Ischemia Study Group (ASIS). J Am Coll Cardiol 1993; 21:1605–1611.
http://www.ncbi.nlm.nih.gov/pubmed/8496526 - Mannheimer C, Carlsson CA, Emanuelsson H, Vedin A, Waagstein F, Wilhelmsson C.
The effects of transcutaneous electrical nerve stimulation in patients with severe angina pectoris. Circulation 1985; 71:308–316.
http://www.ncbi.nlm.nih.gov/pubmed/3871177 - Mannheimer C, Emanuelsson H, Waagstein F, Wilhelmsson C.
Influence of naloxone on the effects of high frequency transcutaneous electrical nerve stimulation in angina pectoris induced by atrial pacing. Br Heart J 1989; 62:36–42.
http://www.ncbi.nlm.nih.gov/pubmed/2788001 - Norrsell H, Eliasson T, Mannheimer C, et al.
Effects of pacinginduced myocardial stress and spinal cord stimulation on whole body and cardiac norepinephrine spillover. Eur Heart J 1997; 18:1890–1896.
http://www.ncbi.nlm.nih.gov/pubmed/9447316 - Cardinal R, Ardell JL, Linderoth B, Vermeulen M, Foreman RD, Armour JA.
Spinal cord activation differentially modulates ischaemic electrical responses to different stressors in canine ventricles. Auton Neurosci 2004; 111:37–47.
http://www.ncbi.nlm.nih.gov/pubmed/15109937 - Foreman RD, Linderoth B, Ardell JL, et al.
Modulation of intrinsic cardiac neurons by spinal cord stimulation: implications for its therapeutic use in angina pectoris. Cardiovasc Res 2000; 47:367–375.
http://www.ncbi.nlm.nih.gov/pubmed/10946073 - Mannheimer C, Augustinsson LE, Carlsson CA, Manhem K, Wilhelmsson C.
Epidural spinal electrical stimulation in severe angina pectoris. Br Heart J 1988; 59:56–61.
http://www.ncbi.nlm.nih.gov/pubmed/3257701 - Sanderson JE, Brooksby P, Waterhouse D, Palmer RB, Neubauer K.
Epidural spinal electrical stimulation for severe angina: a study of its effects on symptoms, exercise tolerance and degree of ischaemia. Eur Heart J 1992; 13:628–633.
http://www.ncbi.nlm.nih.gov/pubmed/1618204 - De Jongste MJ, Hautvast RW, Hillege HL, Lie KI.
Efficacy of spinal cord stimulation as adjuvant therapy for intractable angina pectoris: a prospective, randomized clinical study. Working Group on Neurocardiology. J Am Coll Cardiol 1994; 23:1592–1597.
http://www.ncbi.nlm.nih.gov/pubmed/8195519 - Hautvast RW, de Jongste MJ, Staal MJ, van Gilst WH, Lie KI.
Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study. Am Heart J 1998; 136:1114–1120.
http://www.ncbi.nlm.nih.gov/pubmed/9842028 - Mannheimer C, Eliasson T, Augustinsson LE, et al.
Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY Study. Circulation 1998; 97:1157–1163.
http://www.ncbi.nlm.nih.gov/pubmed/9537342 - Ekre O, Eliasson T, Norrsell H, Wahrborg P, Mannheimer C.
Long-term effects of spinal cord stimulation and coronary artery bypass grafting on quality of life and survival in the ESBY study. Eur Heart J 2002; 23:1938–1945.
http://www.ncbi.nlm.nih.gov/pubmed/12473256 - Murray S, Collins PD, James MA.
An investigation into the ‘carry over’ effect of neurostimulation in the treatment of angina pectoris. Int J Clin Pract 2004; 58:669–674.
http://www.ncbi.nlm.nih.gov/pubmed/15311723 - Di Pede F, Zuin G, Giada F, et al.
Long-term effects of spinal cord stimulation on myocardial ischemia and heart rate variability: results of a 48-hour ambulatory electrocardiographic monitoring. Ital Heart J 2001; 2:690–695.
http://www.ncbi.nlm.nih.gov/pubmed/11666098 - Sanderson JE, Ibrahim B, Waterhouse D, Palmer RB.
Spinal electrical stimulation for intractable angina—long-term clinical outcome and safety. Eur Heart J 1994; 15:810–814.
http://www.ncbi.nlm.nih.gov/pubmed/8088270 - Moore R, Groves D, Nolan J, Scutt D, Pumprla J, Chester MR.
Altered short term heart rate variability with spinal cord stimulation in chronic refractory angina: evidence for the presence of procedure related cardiac sympathetic blockade. Heart 2004; 90:211–212.
http://www.ncbi.nlm.nih.gov/pubmed/14729802 - Sanderson JE.
Electrical neurostimulators for pain relief in angina. Br Heart J 1990; 63:141–143.
http://www.ncbi.nlm.nih.gov/pubmed/2183856 - De Landsheere C, Mannheimer C, Habets A, et al.
Effect of spinal cord stimulation on regional myocardial perfusion assessed by positron emission tomography. Am J Cardiol 1992; 69:1143–1149.
http://www.ncbi.nlm.nih.gov/pubmed/1575182 - Hautvast RW, Blanksma PK, De Jongste MJ, et al.
Effect of spinal cord stimulation on myocardial blood flow assessed by positron emission tomography in patients with refractory angina pectoris. Am J Cardiol 1996; 77:462–467.
http://www.ncbi.nlm.nih.gov/pubmed/8629585 - Mobilia G, Zuin G, Zanco P, et al.
Effects of spinal cord stimulation on regional myocardial blood flow in patients with refractory angina. A positron emission tomography study. G Ital Cardiol 1998; 28:1113–1119.
http://www.ncbi.nlm.nih.gov/pubmed/9834863 - Diedrichs H, Zobel C, Theissen P, et al.
Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation. Curr Control Trials Cardiovasc Med 2005; 6:7.
http://www.ncbi.nlm.nih.gov/pubmed/15943878 - Chauhan A, Mullins PA, Thuraisingham SI, Taylor G, Petch MC, Schofield PM.
Effect of transcutaneous electrical nerve stimulation on coronary blood flow. Circulation 1994; 89:694–702.
http://www.ncbi.nlm.nih.gov/pubmed/8313557 - Norrsell H, Eliasson T, Albertsson P, et al.
Effects of spinal cord stimulation on coronary blood flow velocity. Coron Artery Dis 1998; 9:273–278.
http://www.ncbi.nlm.nih.gov/pubmed/9710687 - Jessurun GA, Tio RA, De Jongste MJ, Hautvast RW, Den Heijer P, Crijns HJ.
Coronary blood flow dynamics during transcutaneous electrical nerve stimulation for stable angina pectoris associated with severe narrowing of one major coronary artery. Am J Cardiol 1998; 82:921–926.
http://www.ncbi.nlm.nih.gov/pubmed/9794345 - Ganz P, Abben RP, Barry WH.
Dynamic variations in resistance of coronary arterial narrowings in angina pectoris at rest. Am J Cardiol 1987; 59:66–70.
http://www.ncbi.nlm.nih.gov/pubmed/3101476 - Spaan JA, Piek JJ, Hoffman JI, Siebes M.
Physiological basis of clinically used coronary hemodynamic indices. Circulation 2006; 113:446–455.
http://www.ncbi.nlm.nih.gov/pubmed/16432075 - Marchand S, Li J, Charest J.
Effects of caffeine on analgesia from transcutaneous electrical nerve stimulation. N Engl J Med 1995; 333:325–326.
http://www.ncbi.nlm.nih.gov/pubmed/7596392 - de Vries J, Anthonio RL, De Jongste MJL, Jessurun GA, Tio RA, Zijlstra F.
The effect of electrical neurostimulation on collateral perfusion. Neth Heart J 2006; 14:209–214. - Southerland EM, Milhorn DM, Foreman RD, et al.
Pre-emptive, but not reactive, spinal cord stimulation mitigates transient ischemia induced myocardial infarction via cardiac adrenergic neurons. Am J Physiol Heart Circ Physiol 2006 Aug 18; Epub ahead of print.
http://www.ncbi.nlm.nih.gov/pubmed/16920800