Spinal Cord Stimulation for Intercostal Neuralgia in a Patient With Implantable Cardiac Defibrillator and Biventricular Pacing

摘要

With the extended clinical indications of dorsal column stimulation therapy for patients with chronic pain, including angina pectoris or intercostal neuralgia, the coexisting indication for an automatic implantable cardioverter defibrillator (ICD) and/or pacemaker is becoming increasingly likely. While there are reports of successful implantation and activity of both these devices in patients with low back or lower limb pain, the spinal cord stimulator (SCS) leads in these cases are usually low thoracic in location. More recently, case reports of successful implantation and activity of both of these devices for patients with refractory angina have become available (1). In this case, our patient had intercostal neuralgia secondary to thoracoscopic epicardial ventricular lead placement and needed placement of an octrode lead at T6. This high thoracic placement was noted to be compatible with the patients ICD and biventricular pacing. Importantly, interferences between devices could result in detection of the high frequency impulses of the neurostimulator followed by inappropriate high volt shock delivery of the ICD, which conversely may lead to malfunction of the SCS.