Clinical follow-up after cessation of chronic electrical neuromodulation in patients with severe coronary artery disease: A prospective randomized controlled study on putative involvement of sympathetic activity

The present study assessed the reoccurrence of myocardial ischemia after wi thholding electrical neurostimulation. After randomization, in the study or withdrawal group, spinal cord stimulation (SCS) was set active during the first 4 weeks, followed by 4 weeks of withholding stimulation. in the contr ol group, SCS was switched off during 4 weeks before the end of the study. The control group had no crossover period. Measurements were done at baseli ne, then after 4 and 8 weeks. The first periods at 4 weeks of each sequence of both groups were compared. In addition, a comparison of clinical variab les was pet-formed between the study group 4 weeks after withholding stimul ation and the control group 4 weeks following randomization. A total number of 24 patients with refractory angina and an implanted spinal cord stimula tor were included in the study (n = 12) and control group. Angina pectoris complaints, nitroglycerin intake, ischemia, and heart rare variability usin g 48-hour ambulatory electrocardiographic monitoring were assessed. In addi tion, neurohormonal status and symptom-limited aerobic capacity were evalua ted. There was no increase of anginal complaints or ischemia after withhold ing stimulation. Neurohormonal levels and aerobic capacity were not altered . We conclude that there is no adverse clinical rebound phenomenon after wi thholding neurostimulation in patients with refractory angina pectoris.