Modulation of intrinsic cardiac neurons by spinal cord stimulation: implications for its therapeutic use in angina pectoris.
Robert D. Foreman,Bengt Linderoth,Jeffrey L. Ardell,Kirk W. Barron,Margaret J. Chandler,Stephen S. Hull,Gert J. Terhorst,Mike J. L. DeJongste,John A Armour +8 more
TLDR
Modulation of the intrinsic cardiac nervous system might contribute to the therapeutic effects of SCS in patients with angina pectoris, as it modifies the capacity of intrinsic cardiac neurons to generate activity.Abstract:
Objective: Electrical stimulation of the dorsal aspect of the upper thoracic spinal cord is used increasingly to treat patients with severe angina pectoris refractory to conventional therapeutic strategies. Clinical studies show that spinal cord stimulation (SCS) is a safe adjunct therapy for cardiac patients, producing anti-anginal as well as anti-ischemic effects. However, little information is yet available about the underlying mechanisms involved. Methods: In order to determine its mechanism of action, the effects of SCS on the final common integrator of cardiac function, the intrinsic cardiac nervous system, was studied during basal states as well as during transient (2 min) myocardial ischemia. Activity generated by intrinsic cardiac neurons was recorded in 9 anesthetized dogs in the absence and presence of myocardial ischemia before, during and after stimulating the dorsal T1–T2 segments of the spinal cord at 66 and 90% of motor threshold using epidural bipolar electrodes (50 Hz; 0.2 ms; parameters within the therapeutic range used in humans). Results: The SCS suppressed activity generated by intrinsic cardiac neurons. No concomitant change in monitored cardiovascular indices was detected. Neuronal activity increased during transient ventricular ischemia (46%), as well as during the early reperfusion period (68% compared to control). Despite that, activity was suppressed during both states by SCS. Conclusions: SCS modifies the capacity of intrinsic cardiac neurons to generate activity. SCS also acts to suppress the excitatory effects that local myocardial ischemia exerts on such neurons. Since no significant changes in monitored cardiovascular indices were observed during SCS, it is concluded that modulation of the intrinsic cardiac nervous system might contribute to the therapeutic effects of SCS in patients with angina pectoris.read more
Citations
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Journal ArticleDOI
Nanomaterials for Neural Interfaces
Nicholas A. Kotov,Jessica O. Winter,Isaac P. Clements,Edward Jan,Brian P. Timko,Stéphane Campidelli,Smita Pathak,Andrea Mazzatenta,Charles M. Lieber,Charles M. Lieber,Maurizio Prato,Ravi V. Bellamkonda,Gabriel A. Silva,Nadine Wong Shi Kam,Fernando Patolsky,Laura Ballerini +15 more
TL;DR: This review focuses on the application of nanomaterials for neural interfacing, covering a variety of specific applications of nanoengineered devices, including drug delivery, imaging, topographic patterning, electrode design, nanoscale transistors for high‐resolution neural interfaced, and photoactivated interfaces.
Journal ArticleDOI
The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases: The Neuromodulation Appropriateness Consensus Committee
Timothy R. Deer,Nagy Mekhail,David Provenzano,Jason E. Pope,Elliot S. Krames,Michael S. Leong,Robert M. Levy,David Abejón,Eric Buchser,Allen W. Burton,Asokumar Buvanendran,Kenneth D. Candido,David Caraway,Michael J. Cousins,Mike J. L. DeJongste,Sudhir Diwan,Sam Eldabe,Kliment Gatzinsky,Robert D. Foreman,Salim M. Hayek,Philip Kim,Philip Kim,Thomas M. Kinfe,David Kloth,Krishna Kumar,Syed Rizvi,Shivanand P. Lad,Liong Liem,Bengt Linderoth,Sean Mackey,Gladstone C. McDowell,Porter McRoberts,Lawrence Poree,Joshua P. Prager,Lou Raso,Richard Rauck,Marc Russo,Brian A. Simpson,Konstantin V. Slavin,Peter S. Staats,Michael Stanton-Hicks,Paul Verrills,Joshua Wellington,Kayode Williams,Richard B. North +44 more
TL;DR: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neurodulation Society evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications.
Patent
Method and apparatus for electrically stimulating the nervous system to improve ventricular dysfunction, heart failure, and other cardiac comditions
TL;DR: In this article, a method and apparatus are used to provide therapy to a patient experiencing ventricular dysfunction or heart failure, where electrical stimulation is applied to the at least one electrode to improve the cardiac efficiency of the patient's heart.
Patent
Closed-loop neuromodulation for prevention and treatment of cardiac conditions
TL;DR: In this article, a closed-loop feedback controller is used to apply electrical stimulation to preselected regions of the patient's body, and then the patient is monitored to determine the efficacy of the stimulation.
Journal ArticleDOI
The Role of the Autonomic Nervous System in Sudden Cardiac Death
TL;DR: The anatomy of both systems, the sympathetic and the parasympathetic systems, are described, which are complex and susceptible to control at several levels, from centrally mediated baroreceptors and chemoreceptors to local interneuronal interactions.
References
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Journal ArticleDOI
Electrical Stimulation Versus Coronary Artery Bypass Surgery in Severe Angina Pectoris The ESBY Study
Clas Mannheimer,Tore Eliasson,L.-E. Augustinsson,Christian Blomstrand,Håkan Emanuelsson,Sture Larsson,Henrik Norrsell,Åke Hjalmarsson +7 more
TL;DR: It seems reasonable to conclude that SCS may be a therapeutic alternative for patients with an increased risk of surgical complications and effects on ischemia, morbidity, and mortality should be considered in the choice of treatment method.
Journal ArticleDOI
Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study.
TL;DR: Spinal cord stimulation is effective in chronic intractable angina pectoris, and its effect is exerted through anti-ischemic action, unlikely to be explained as a placebo effect from surgery.
Journal ArticleDOI
Spinal cord stimulation attenuates dorsal horn neuronal hyperexcitability in a rat model of mononeuropathy
TL;DR: The results suggest that SCS may provide a suppressive action on dorsal horn neuronal hyperexcitability associated with signs of peripheral neuropathy, and this effect presumably corresponds to a normalization of the excitability of WDR cells in response to innocuous stimuli.
Journal ArticleDOI
Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action.
Clas Mannheimer,T. Eliasson,Bert Andersson,C H Bergh,L.-E. Augustinsson,Håkan Emanuelsson,Finn Waagstein +6 more
TL;DR: Spinal cord stimulation has an anti-anginal and anti-ischaemic effect in severe coronary artery disease and seems to be secondary to a decrease in myocardial oxygen consumption.
Journal ArticleDOI
Myocardial ischaemia and the cardiac nervous system
TL;DR: Some tentative ideas concerning the importance of this nervous system in cardiac disease states are provided with a view to stimulating further interest in neural control of the heart so that appropriate neurocardiological strategies can be devised for the management of heart disease.