Clinical effects

Multiple studies have demonstrated consistent clinical improvement from the application of SCS. Early work by Mannheimer et al.37[III] involved a study of 20 patients with refractory, treatment-resistant angina pectoris. Atrial pacing-induced tachycardia and myocardial oxygen consumption were compared with or without spinal stimulation. During SCS, patients tolerated higher levels of pacing, prolonged time of pacing-induced chest pain, and reduced oxygen consumption. Hautvast and his group prospectively compared chronic angina patients with or without SCS.38[III] Both duration of exercise and time period to angina increased during SCS. Nitrate consumption and angina attack frequency decreased during the study. Pain relief and quality of life were improved. Later, the same group assessed myocardial blood flow by positron emission tomography (PET) and were not able to demonstrate a change in blood flow despite substantial decreases in angina attacks, improved exercise and decreased S-T segment depression. It appeared that SCS worked by homogenization of cardiac blood flow at the expense of reserve flow.39

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