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New treatment for painful angina.

Over six million Americans live with a painful chest condition called angina pectoris, resulting from blockages in the arteries that supply blood to the heart or other coronary disease. For most individuals suffering from the disease, conventional interventions--nitroglycerin, angioplasty or bypass surgery--help ease the discomfort. But for 35,000 individuals with the toughest cases of angina, pare persists despite optimal conventional treatment. Relief, however, may be in sight.

Researchers in the United States are investigating a promising new therapy called spinal cord stimulation that has helped many patients around the world cope with intractable angina pectoris. Dr. Douglas Zipes--editor-in-chief of Neighborhood Heart Watch newsletter and noted electrophysiologist from IU School of Medicine--is lead investigator of the multicenter clinical trial, which will evaluate the safety and effectiveness of mild electrical stimulation of the spinal cord in reducing the pain of severe, chronic, stable angina. Encouraged by results from clinical trials in Europe, Canada, and Australia, Dr. Zipes is looking forward to the outcome of the United States study.

"There have been at least 500 implants in Europe with excellent results," says Dr. Zipes, distinguished professor of medicine and director of the Krannert Institute of Cardiology at IU School of Medicine. "Carefully controlled studies to evaluate this technique are now needed. Success in a clinical trial would solve a frustrating medical problem and enhance the lives of many patients whose quality of life is restricted by almost constant pain."

Angina patients receiving the therapy outside the United States experienced pain relief with less medicine and fewer visits to the emergency room.

"We're using spinal cord stimulation in patients who have non-revascularizable coronary disease and are suffering from angina, which means that patients are receiving maximal drug treatment and are ineligible for angioplasty or stents for a variety of reasons," explains Dr. Zipes. "It's now been shown that spinal cord stimulation reduces chest pain in these patients. We've shown that it affects the autonomic nervous system by decreasing sympathetic activity and increasing vagal activity. That may be the way the chest pain is reduced. Alternatively, it may be improving blood flow to the ischemic myocardium."

Spinal cord stimulation is already being used to treat chronic pain due to back problems, cancer, and other type of chronic pain. The therapy is also used to help address the severe pain of peripheral vascular disease (PVD).

"It is being used in lower-extremity claudication or for insufficient blood flew to the lower extremity," adds Dr. Zipes. "It appears that the therapy improves blood flow to the limbs as well."

The procedure is performed under a local anesthetic. An electrode is placed inside the tissues that surround the spinal column in the upper back. The electrode is then connected to an electrical generator sitting beneath the skin under the left rib cage. The generator emits a weak electrical signal several times daily that helps prevent the angina.

The 20-center trial has begun and is actively recruiting patients. To learn more about the trial and enrollment, contact the office of Dr. Douglas Zipes at 317-962-0555.
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Title Annotation:Neighborhood Heart Watch; Spinal cord stimulation
Author:Zipes, Douglas
Publication:Medical Update
Geographic Code:1USA
Date:Mar 1, 2003
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