CURRENT VIEWS ON NEUROSTIMULATION IN THE TREATMENT OF CARDIAC ISCHEMIC SYNDROMES

Most clinicians are still unacquainted with the beneficial effects of neurostimulation as an additional therapeutic strategy for severe angi na pectoris. Patients with therapeutically refractory angina pectoris suffer from chest discomfort during minimal exercise, despite maximal tolerated antianginal drug therapy (at least 2 out of a beta-blocker, calcium-antagonist or long-acting nitrate). In these patients, revascu larization procedures, such as a percutaneous transluminal coronary an gioplasty or coronary artery bypass surgery, are often technically imp ossible because of diffuse coronary artery disease or should be withhe ld as a consequence of absolute contraindications such as severe left ventricular dysfunction. All patients have inoperable multivessel dise ase, experienced one or more myocardial infarctions, and were treated by earlier invasive interventions. This group of patients are severely physically and psychologically disabled by their intractable angina p ectoris. Available published data and the neurostimulation experience of the authors are reviewed in relation to the treatment of cardiac is chemic syndromes. We conclude that neurostimulation is an effective th erapeutic adjuvant for patients with severe angina pectoris unresponsi ve to standard treatment. This treatment modality appears to be safe, and a promising tool for other ischemic cardiac syndromes.