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Effects of Spinal Cord Stimulation on Cardiac Sympathetic Nerve Activity in Patients with Heart Failure
Author(s) -
NAAR JAN,
JAYE DEBORAH,
LINDE CECILIA,
NEUŽIL PETR,
DOŠKÁŘ PETR,
MÁLEK FILIP,
BRAUNSCHWEIG FRIEDER,
LUND LARS H.,
MORTENSEN LARS,
LINDEROTH BENGT,
LIND GÖRAN,
BONE DIANNA,
SCHOLTE ARTHUR J.,
KUEFFER FRED,
KOEHLER JODI,
SHAHGALDI KAMBIZ,
LANG OTTO,
STÅHLBERG MARCUS
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13050
Subject(s) - medicine , heart failure , cardiology , ejection fraction , heart rate , cardiac function curve , anesthesia , blood pressure
Background Spinal cord stimulation (SCS) reduces sympathetic activity in animal models of heart failure with reduced ejection fraction (HF) but limited data exist of SCS in patients with HF. The aim of the present study was to test the primary hypothesis that SCS reduces cardiac sympathetic nerve activity in HF patients. Secondary hypotheses were that SCS improves left ventricular function and dimension, exercise capacity, and clinical variables relevant to HF. Methods HF patients with a SCS device previously participating in the DEFEAT‐HF trial were included in this crossover study with 6‐week intervention periods (SCS‐ON and SCS‐OFF). SCS (50 Hz, 210‐μs pulse duration, aiming at T2–T4 segments) was delivered for 12 hours daily. Indices of myocardial sympathetic neuronal function (heart‐to‐mediastinum ratio, HMR) and activity (washout rate, WR) were assessed using 123 I‐metaiodobenzylguanidine (MIBG) scintigraphy. Echocardiography, exercise testing, and clinical data collection were also performed. Results We included 13 patients (65.3 ± 8.0 years, nine males) and MIBG scintigraphy data were available in 10. HMR was not different comparing SCS‐ON (1.37 ± 0.16) and SCS‐OFF (1.41 ± 0.21, P = 0.46). WR was also unchanged comparing SCS‐ON (41.5 ± 5.3) and SCS‐OFF (39.1 ± 5.8, P = 0.30). Similarly, average New York Heart Association class (2.4 ± 0.5 vs 2.3 ± 0.6, P = 0.34), quality of life score (24 ± 16 vs 24 ± 16, P = 0.94), and left ventricular dimension and function as well as exercise capacity were all unchanged comparing SCS‐ON and SCS‐OFF. Conclusion In patients with HF, SCS (12 hours daily, targeting the T2–T4 segments of the spinal cord) does not appear to influence cardiac sympathetic neuronal activity or function as assessed by MIBG scintigraphy.