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

Raul D. Mitrani, Lawrence S. Klein, William M. Miles, F. Kevin Hackett, Robert W. Burt, Henry N. Wellman, Douglas P. Zipes

Research output: Contribution to journalArticle

116 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1344-1353
Number of pages10
JournalJournal of the American College of Cardiology
Volume22
Issue number5
DOIs
StatePublished - Nov 1 1993

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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