Neuronal Control of the Heart
Document Type
Book Contribution
Publication Date
12-1-2009
Description
This chapter focuses on the use of spinal cord stimulation (SCS) for neuronal control of heart. Myocardial ischemia evokes a myriad of responses from the heart itself, to the neurohumoral systems that modulate it, to behavioral consequences including the perception of pain. The treatment of myocardial ischemia and resultant cardiac pain has evolved from bed rest, to the advent of pharmacological and surgical approaches targeted at coronary blood flow and heart muscle, to the concept of therapies based upon modulating the interdependent interactions between the heart and its associated neurohumoral control systems. Neuromodulation therapy, using electrical stimulation of peripheral (TENS) or central (spinal cord stimulation, SCS) sites, is one such emerging therapy. It has a clinical history of over 20 years in treating cardiac pain, especially in patients refractory to conventional surgical or pharmacological approaches. Recognized patient benefits to SCS include reduced ST segment alterations induced during exercise, improved myocardial lactate metabolism, and increased workload tolerance. SCS modifies and modulates the myocytes along with the primary neural control mechanisms that regulate the heart. SCS for treatment of angina pectoris has proved to be much more effective and dependable than when used for neuropathic pain conditions. The success rate for relieving angina pectoris is often in the range of 80% or greater after several years of follow-up. Besides the reduction in angina pectoris, clinical studies have shown that SCS also reduces the ischemia associated with exertional stress while maintaining the pain response to critical levels of ischemia.
Citation Information
Ardell, Jeffrey L.; and Foreman, Robert D.. 2009. Neuronal Control of the Heart. Neuromodulation. Vol.2 793-799. https://doi.org/10.1016/B978-0-12-374248-3.00065-3 ISBN: 9780123742483