The use of spinal cord stimulation for the patient with ventricular arrhythmia, atrial fibrillation and pulmonary hypertension

Authors: Yakovlev A.E..1, 2, Yakovleva M.V..1

Company: 1 Medelect Clinic, Moscow, Russian Federation
2 P.V. Mandryk Central Military Clinical Hospital, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Clinical Cases


DOI: https://doi.org/10.24022/1997-3187-2024-18-1-104-112

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



Subscribe 🔒

 

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.

References

  1. Packer D.L., Mark D.B., Robb R.A., Monahan K.H., Bahnson T.D., Poole J.E. et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019; 321 (13): 1261–1274. DOI: 10.1001/jama.2019.0693
  2. Waldron N.H., Fudim M., Mathew J.P., Piccini J.P. Neuromodulation for the treatment of heart rhythm disorders. JACC: Basic Transl. Sci. 2019; 4 (4): 546–562. DOI: 10.1016/j.jacbts.2019.02.009
  3. Zhu C., Hanna P., Rajendran P.S., Shivkumar K. Neuromodulation for ventricular tachycardia and atrial fibrillation: a clinical scenario-based review. J. Am. Coll. Cardiol. EP. 2019; 5 (8): 881–896. DOI: 10.1016/j.jacep.2019.06.009
  4. Shen M.J., Zipes D.P. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circ. Res. 2014; 114 (6): 1004–1021. DOI: 10.1161/CIRCRESAHA.113.302549
  5. Krul S.P., Berger W.R., Veldkamp M.W., Driessen A., Wilde A.M., Deneke Th. et al. Treatment of Atrial and ventricular arrhythmias through autonomic modulation. JACC: Clin. Electrophysiol. 2015; 1 (6): 496–508. DOI: 10.1016/j.jacep.2015.09.013
  6. Dusi V., de Ferrari G.M., Mann D.I. Cardiac Sympathetic – parasympathetic interaction. JACC: Basic Transl. Sci. 2020; 5 (8): 811–814. DOI: 10.1016/j.jacbts.2020.07.004
  7. He B., Scherlag B.J., Nakagawa H., Lazzara R., Po S. The intrinsic autonomic nervous system in atrial fibrillation: a review. ISRN Cardiol. 2012; 2012: 490674. DOI: 10.5402/2012/490674 8. Markman T.M., Gugger D., Arkles J., Riley M.P., Dixit S., Guandalini G.S. et al. Neuromodulation for the treatment of refractory ventricular arrhythmias. JACC: Clin. Electrophysiol. 2023; 9 (2): 161–169. DOI: 10.1016/j.jacep.2022.08.031
  8. Ardell J.L., Cardinal R., Beaumont E., Vermeulen M., Smith F.M., Armour A.J. Chronic spinal cord stimulation modifies intrinsic cardiac synaptic efficacy in the suppression of atrial fibrillation. Auton. Neurosci. Basic. Clin. 2014; 186: 38–44. DOI: 10.1016/j.autneu.2014.09.017
  9. Grimaldi R., de Luca A., Kornet L., Castagno D., Gaita F. Can spinal cord stimulation reduce ventricular arrhythmias? Heart Rhythm. 2012; 9 (11): 1884–1887. DOI: 10.1016/j.hrthm.2012.08.007
  10. Dusi V., Angelini F., Zile M.R., De Ferrari G.M. Neuromodulation devices for heart failure. Eur. Heart J. Suppl. 2022; 24 (Suppl. E): 12–27. DOI: 10.1093/eurheartjsupp/suac036
  11. Cruccu G., Aziz T.Z., Garcia-Larrea L., Hansson P., Jensen T.S., Lefaucheur J.P. et al. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur. J. Neurol. 2007; 9: 952–970. DOI: 10.1111/j.1468-1331.2007.01916
  12. Mesa J.E., Yakovlev A.E. Treatment of intractable angina pectoris utilizing spinal cord stimulation. Rev. Cardiovasc. Med. 2008; 9 (1): 70–74.
  13. Yakovlev A.E., Yakovleva M.V., Chaykovskaya M.K., Ardashev A.V. The first in Russia experience of successful implementation of constant neurostimulation of the spinal cord in the complex treatment of a patient with permanent form of atrial fibrillation combined with spinal stenosis. Kardiologiia. 2019; 59 (9): 83–90 (in Russ.). DOI: 10.18087/cardio.2019.9.10272
  14. Yakovlev A.E., Yakovleva M.V., Chaykovskaya M.K. Experience of clinical observation of patients with combined cardiological and neurological pathology: an innovative approach to the treatment of atrial fibrillation. Journal of Arrhythmology. 2019; 1 (95): 57–60 (in Russ.). DOI: 10.25760/VA-2019-95-57-60
  15. Romanov A., Lomivorotov V., Chernyavskiy A., Murtazin V., Kliver E., Ponomarev D. et al. Temporary spinal cord stimula-tion to prevent postcardiac surgery atrial fibrillation. J. Am. Coll. Cardiol. 2022; 79 (7): 754–756. DOI: 10.1016/j.jacc. 2021.08.078
  16. Sobowale Ch.O., Hori Y., Ajijola O.A. Neuromodulation therapy in heart failure: combined use of drugs and devices. J. Innov. Cardiac. Rhythm. Manage. 2020; 11 (7): 4151–4159. DOI: 10.19102/icrm.2020.110705
  17. Hung-Fat Tse, Sanders P., Okuyama Y., Fujiu K. Thoracic spinal cord stimulation for heart failure as a restorative treatment (SCS HEART study): first-in-man experience. Heart Rhythm. 2015; 12 (3): 588–595. DOI: 10.1016/j.hrthm.2014.12.014
  18. Zipes D.P., Neuzil P., Theres H., Caraway D., Mann D.L., Mannheimer C. et al. The DEFEAT-HF Study. JACC: Heart Fail. 2016; 4 (2): 129–136. DOI: 10.1016/j.jchf.2015.10.006

About Authors

  • Aleksandr E. Yakovlev, Head of the Department, Neurosurgeon; ORCID
  • Marina V. Yakovleva, Cardiologist, Chief Physician; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery