Extracorporeal cardiac shock wave therapy: first experience in the everyday practice for treatment of chronic refractory angina pectoris.

Several alternative therapies have emerged for treating patients with chronic refractory angina pectoris, yet only a few have given rise to sufficiently published data regarding safety and effectiveness. It is imperative to establish an effective and preferably non-invasive therapy for this expanding patient cohort. We report initial experience with cardiac shock wave therapy (CSWT) in the everyday practice for refractory angina. Ten patients with chronic refractory angina pectoris were enrolled for CSWT at our institution. All were symptomatic on minimal activity (CCS class III or IV) inspite of receiving maximally tolerated medical therapy. They showed evidence of myocardial ischemia on exercise Tc SPECT perfusion scans with no possibility for coronary percutaneous intervention or bypass grafting on a recent angiogram. The patients were subjected to 9 CSWT sessions (3 cycles) over 3 months. All patients gave written informed consents. The MODULITH SLC (Storz Medical AG, Kreuzlingen – Switzerland) was used throughout this treatment. The physical principles, mechanism of action and technical details of shock waves and the above-mentioned generator have been described elsewhere [1]. Briefly, this device is able to precisely focus shock waves transthoracically on the desired segment of the heart under the guidance of an in-line 2-D echocardiography. Shock waves are applied in an Rwave triggered manner to avoid ventricular arrhythmias. The shock wave is a mechanical force that induces local shear