Successful Use of the MODULITH SLC at the Inselspital, Bern University Hospital

Interview with the CSWT expert PD Dr Jean-Paul Schmid

Dear Dr Schmid, your clinic has been using shock waves in cardiology with success since 2006 to treat refractory angina pectoris. Personally, you have been working with the innovative MODULITH® SLC for 8 years. This device is now used quite successfully in many renowned clinical centres for the non-invasive revascularization of the heart.

What is your clinical experience with cardiac shock wave therapy (CSWT)?

Dr Schmid: We have gained excellent experience with CSWT. Consequently, I am personally convinced that this is a successful method and therefore, I can tell the patient before the treatment starts that the prospects of success are high. Experience clearly shows that one crucial factor of success is the right patient selection. It is important to ensure that the pain is caused by decreased blood flow and not by any other cause of non-ischemic origin. This needs to be clarified by means of a stress test or by myocardial imaging methods, which will also show the region that needs to be treated.

How does CSWT work?

Dr Schmid: Many studies have shown that local blood circulation increases as a consequence of improved microcirculation. Myocardial imaging methods as well as basic research experiments have demonstrated this effect. Vascular growth factors are upregulated and there is a rise in capillary density.

What is the development of indications from the beginnings (with mainly »no option patients«) to this day? For which indications is CSWT used today?

Dr Schmid: The typical CSWT patient has undergone an invasive work-up and becomes a candidate for CSWT because of reoccurrence of pain and lack of invasive or surgical treatment option. But finally every patient with a stable angina pectoris is a candidate for CSWT.

How do the patients respond to the treatment?

Dr Schmid: We have actually a very high success rate of more than 80 per cent of patients who respond positively to the CSWT treatment. The effects begin to show between 8 and 16 weeks after starting the therapy and last at least for one year. If the problems recur there is always the possibility to repeat the treatment.

What is the therapy plan like, how often will a patient be treated?

Dr Schmid: To begin with, our therapy plan provides for three treatment sessions of 2400 shocks each within one week. After that, there will be three months of treatment with one week of three sessions each until a total number of 9 sessions has been reached. For us, this therapy plan has proven to be efficient in practice.

If you look at the latest results concerning arrhythmia or applications in cases of heart failure, how would you judge the chances for these applications in the future?

Dr Schmid: There is a high potential for applying CSWT in cases of chronic ischemic cardiopathy with symptoms of heart failure, however, we need more data which would allow us to come to definitive conclusions.

Dr Schmid, could you tell us spontaneously what you think about CSWT, put in a nutshell?

Dr Schmid: CSWT is a non-invasive method that is very simple to apply and has a high potential to significantly improve the symptoms in patients who suffer from chronic angina pectoris.

Dr Schmid, thank you very much for this interview!

Dr. Schmid  

PD Dr Jean-Paul Schmid
Deputy director,
Cardiovascular Prevention and Rehabilitation,
Inselspital, Bern University Hospital



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Lunedì, 10 Agosto 2020

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