Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine

Marshall S. Stanton, Mahmoud M. Tuli, Nancy L. Radtke, James J. Heger, William M. Miles, Bruce H. Mock, Robert W. Burt, Henry N. Wellman, Douglas P. Zipes

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Abstract

Transmural myocardial infarction in dogs produces denervation of sympathetic nerves in viable myocardium apical to the infarct that may be arrhythmogenic. It is unknown whether sympathetic denervation occurs in humans. The purpose of this study was to use iodine- 123-metaiodobenzylguanidine (MIBG), a radiolabeled guanethidine analog that is actively taken up by sympathetic nerve terminals, to image noninvasively the cardiac sympathetic nerves in patients with and without ventricular arrhythmias after myocardial infarction. Results showed that 10 of 12 patients with spontaneous ventricular tachyarrhythmias after myocardial infarction exhibited regions of thallium-201 uptake indicating viable perfused myocardium, with no MIBG uptake. Such a finding is consistent with sympathetic denervation. One patient had frequent episodes of nonsustained ventricular tachycardia induced at exercise testing that was eliminated by beta-adrenoceptor blockade. Eleven of the 12 patients had ventricular tachycardia induced at electrophysiologic study and metoprolol never prevented induction. Sympathetic denervation was also detected in two of seven postinfarction patients without ventricular arrhythmias. Normal control subjects had no regions lacking MIBG uptake. This study provides evidence that regional sympathetic denervation occurs in humans after myocardial infarction and can be detected noninvasively by comparing MIBG and thallium-201 images. Although the presence of sympathetic denervation may be related to the onset of spontaneous ventricular tachyarrhythmias in some patients, it does not appear to be related to sustained ventricular tachycardia induced at electrophysiologic study.

Original languageEnglish
Pages (from-to)1519-1526
Number of pages8
JournalJournal of the American College of Cardiology
Volume14
Issue number6
DOIs
StatePublished - Nov 15 1989

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Sympathectomy
Myocardial Infarction
Ventricular Tachycardia
Thallium
Tachycardia
Cardiac Arrhythmias
Myocardium
Guanethidine
Metoprolol
Iodine
Adrenergic Receptors
Dogs
Exercise

ASJC Scopus subject areas

  • Nursing(all)

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Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine. / Stanton, Marshall S.; Tuli, Mahmoud M.; Radtke, Nancy L.; Heger, James J.; Miles, William M.; Mock, Bruce H.; Burt, Robert W.; Wellman, Henry N.; Zipes, Douglas P.

In: Journal of the American College of Cardiology, Vol. 14, No. 6, 15.11.1989, p. 1519-1526.

Research output: Contribution to journalArticle

Stanton, Marshall S. ; Tuli, Mahmoud M. ; Radtke, Nancy L. ; Heger, James J. ; Miles, William M. ; Mock, Bruce H. ; Burt, Robert W. ; Wellman, Henry N. ; Zipes, Douglas P. / Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine. In: Journal of the American College of Cardiology. 1989 ; Vol. 14, No. 6. pp. 1519-1526.
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