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Europace Advance Access originally published online on March 12, 2008
Europace 2008 10(4):506-508; doi:10.1093/europace/eun052
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

T WAVE ALTERNANS

Spinal cord stimulation affects T-wave alternans in patients with ischaemic cardiomyopathy: a pilot study

Paolo Ferrero1,*, Davide Castagno1, Riccardo Massa1, Anna De Luca2, Maddalena Castellano2, Claudio Chirio1 and Roberto Grimaldi1

1 UOADU Cardiology San Giovanni Battista, Corso Bramante 88, Turin 10100, Italy; 2 UOADO Antalgic Therapy San Giovanni Battista, Corso Bramante 88, Turin 10100, Italy

Aims: An antiarrhythmic effect of spinal cord stimulation (SCS) has been recognized in an animal model. The actual mechanism is still mainly unknown. An adrenergic output reduction has been advocated as the main mechanism, although a modulation effect on the arrhythmic substrate has not yet been investigated. We studied T-wave alternans (TWA) modifications to test the hypothesis that SCS affects the arrhythmic substrate.

Methods and results: We performed TWA assessment in three high-risk patients who previously had undergone implantation of both implantable cardioverter defibrillator and SCS to treat refractory angina. The test was performed after switching off the SCS and after 2 and 24 h stimulation at the default amplitude. The protocol was executed 2 months apart in order to assess the reproducibility of the results, collecting a total of 18 TWA reports. In all the three patients, we observed a significant reduction of TWA amplitude after 2 h stimulation. All the tests were classified as negative after 24 h stimulation with the nominal parameters.

Conclusion: Spinal cord stimulation results in a decrease in the TWA magnitude, and thus it seems to positively affect the arrhythmic substrate in a time-dependent manner.

Key Words: Cardiomyopathy, Spinal cord stimulation, Arrhythmia, T wave alternans

* Corresponding author. Tel: +39 0116334446; fax: +39 0116335572.E-mail address: ferpaolo77{at}libero.it

Manuscript submitted 22 December 2007. Accepted after revision 11 February 2008.


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