The use of spinal cord stimulation for the patient with ventricular arrhythmia, atrial fibrillation and pulmonary hypertension
Authors:
Company:
1 Medelect Clinic, Moscow, Russian Federation
2 P.V. Mandryk Central Military Clinical Hospital, Moscow, Russian Federation
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Type: Clinical Cases
DOI:
For citation: Yakovlev A.E., Yakovleva M.V. The use of spinal cord stimulation for the patient with ventricular arrhythmia, atrial fibrillation and pulmonary hypertension. Creative Cardiology. 2024; 18 (1): 104–112 (in Russ.). DOI: 10.24022/1997-3187-2024-18-1-104-112
Received / Accepted: 23.01.2024 / 01.03.2024
Keywords: premature ventricular contractions ventricular tachycardia atrial fibrillation pulmonary hypertension chronic heart failure sympathetic nervous system parasympathetic nervous system antiarrhythmic drug therapy radiofrequency ablation neuromodulation spinal cord stimulation
Abstract
Spinal cord stimulation (SCS) is one of the techniques commonly used in functional neurosurgery for the treatment of pain syndromes and movement disorders (chronic pain syndromes of various etiologies, cerebral palsy (CP), spastic form of multiple sclerosis, consequences of spinal cord injuries, complications of stroke, etc.).
For cardiac patients, the technique was first used more than 25 years ago in the treatment of coronary heart disease (CHD), as an alternative to aorto-coronary bypass surgery in patients with a high risk of surgical treatment. Stimulation of the upper parts of the spinal cord (C6–Th5) leads to suppression of sympathetic tone and the predominance of parasympathetic influences on the heart, which causes not only dilatation of the coronary arteries, but also the opening of collaterals, increased synthesis of nitric oxide (NO), activation angiogenesis. These effects of SCS lead to improved blood supply to the myocardium, relief of angina symptoms, increased exercise tolerance. Low invasiveness of the technique minimizes surgical risks.
Currently, in the treatment of patients with chronic vertebrogenic pain syndromes, especially in older age groups burdened with concomitant cardiac pathology, the method of SCS is increasingly used, which allows not only to control the pain syndrome, but also provides sustainable cardiotropic effects. The article presents the successful experience of SCS technique use in an elderly comorbid patient with coronary artery disease, chronic heart failure, high-grade ventricular arrhythmias, paroxysmal atrial fibrillation and pulmonary hypertension leading to an improvement in the functional class of chronic heart failure, control of sinus rhythm, and a decrease in the level of pressure in the pulmonary artery.
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