Neurostimulation treatment for angina pectoris.

Despite the wealth of treatments available for the management of angina pectoris, a significant proportion of patients remain refractory. These patients seem to be survivors, so that an individual with refractory angina may suVer with it for many years; consequently patients with refractory angina pectoris usually require multiple admissions, often to expensive cardiac units. Recently transmyocardial laser revascularisation (TMLR) has enjoyed considerable world wide popularity as a potential treatment strategy. However, the recently published TMLR trial from Papworth Hospital led the investigators to conclude that they cannot advocate the adoption of TMLR for the management of refractory angina. Neurostimulation presents an alternative treatment strategy for which eYcacy data continues to grow, although there has not yet been a large randomised controlled trial into its use in the treatment of refractory angina. This article summarises neurostimulation research to date and reviews the current theories on the mechanisms of action.