Regional cardiac sympathetic denervation in patients with ventricular tachycardia in the absence of coronary artery disease

• Published in: Journal of the American College of Cardiology Vol. 22; no. 5; pp. 1344 - 1353
• Main Authors: Mitrani, Raul D., Klein, Lawrence S., Miles, William M., Hackett, F.Kevin, Burt, Robert W., Wellman, Henry N., Zipes, Douglas P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-1993; Elsevier Science
• Subjects: 3-Iodobenzylguanidine; Adolescent; Adult; Aged; Autonomic Nervous System Diseases - complications; Autonomic Nervous System Diseases - diagnostic imaging; Biological and medical sciences; Cardiac Catheterization; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiomyopathies - complications; Cardiomyopathies - diagnostic imaging; Case-Control Studies; Catheter Ablation; Child; Echocardiography; Electrophysiology; Exercise Test; Female; Heart; Heart Valve Diseases - complications; Heart Valve Diseases - diagnostic imaging; Humans; Hypertrophy, Left Ventricular - complications; Hypertrophy, Left Ventricular - diagnostic imaging; Iodine Radioisotopes; Iodobenzenes; Male; Medical sciences; Middle Aged; Sympathetic Nervous System; Tachycardia, Ventricular - classification; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - surgery; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Radionuclide study; Heart; Human; Nervous system diseases; Arrhythmia; Pathogenesis; Cardiovascular disease; Scintigraphy; Excitability disorder; Heart disease; Diseases of the autonomic nervous system; Paroxysmal ventricular tachycardia; Sympathic nervous system; Denervation
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(93)90541-8

Objective. The aim of this study was to determine whether patients with ventricular arrhythmias in the absence of coronary artery disease also have abnormalities in sympathetic innervation.
Background. We have previously shown by cardiac sympathetic scintigraphy using iodine-123-metasiodobenzylguanidine (I-123-MIBG) that patients with ventricular tachycardia after myocardial infarction have regional cardiac sympathetic denervation. It is not known whether patients with ventricular tachycardia in the absence of coronary artery disease also have regional cardiac sympathetic denervation.
Method. We performed cardiac I-123-MIBG and thallium-201 single-photon emission computed tomographic (SPECT) scans at rest in 18 patients (mean age 47 ± 18 years) with cardiomyopathy (n = 6), left ventricular hypertrophy (n = 1), valvular disease (n = 2) or a structurally normal heart (n = 9) who presented with monomorphic (n = 15) or polymorphic (n = 3) ventricular tachycardia. These scans were compared with scans in 12 control patients without ventricular tachycardia (mean age 30 ± 17 years) who had cardiomyopathy (n = 3) or a structurally normal heart (n = 9). Cardiac sympathetic denervation was defined as myocardial areas having thallium uptake with reduced or absent I-123-MIBG uptake.
Results. Twelve (67%) of 18 patients with ventricular tachycardia had regional cardiac sympathetic denervatlon compared with 1 (8%) of 12 patients who did not have ventricular tachycardia (p = 0.002). In the nine patients with a structurally normal heart and ventricular tachycardia, five (55%) patients had regional cardiac sympathetic denervatlon compared with zero of nine control patients with a structurally normal heart (p = 0.029). Five patients underwent right ventricular radiofrequency ablation for ventricular tachycardia, and sympathetic denervatton was adjacent to the ablation site in one of these patients.
Conclusions. Patients with ventricular tachycardia in the absence of coronary artery disease have abnormal cardiac sympathetic innervation detectable by cardiac sympathetic scintigraphy. The rote of regional cardiac sympathetic denervatton in arrhythmogenesis remains to be determined.