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Cardiac sympathetic denervation predictive of ventricular arrhythmias

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Cardiac sympathetic denervation on late 123-iodine meta-iodobenzylguanidine imaging predicted ventricular arrhythmias causing implantable cardioverter defibrillator therapy, according to study findings.

Researchers enrolled 116 patients with advanced HF (mean age, 65 ±9 years) undergoing cardiac 123-iodine meta-iodobenzylguanidine (123-I MIBG) imaging for HF risk stratification. The patients had been clinically referred for ICD implantation because of poor left ventricular function with or without non-sustained ventricular tachycardia (primary prevention) or prior sustained ventricular tachycardia or ventricular fibrillation (secondary prevention).

During a mean follow-up of 23 ± 15 months, researchers documented both appropriate ICD therapy (primary endpoint; n=24) and appropriate ICD therapy or cardiac death (secondary endpoint; n=32). Late 123-I MIBG single-photon emission CT defect score was an independent predictor for both endpoints. Patients with a large late 123-I MIBG SPECT defect (summed score >26) had more appropriate ICD therapy (52% vs. 5%, P<.01) and more appropriate ICD therapy or cardiac death (57% vs. 10%, P<.01) than patients with a small defect (summed score ≤26) at 3-year follow-up.

Study limitations included scoring of innervation and perfusion scans visually; the potential for limiting the 123-I MIBG SPECT imaging in patients with severe LV dysfunction by reduced myocardial tracer uptake, hampering the acquisition of tomographic images of the heart; and the heterogeneous population of the study, which included patients with ischemic and nonischemic cardiomyopathy. Regarding the latter, “Additional studies are needed to establish the specific role of 123-I MIBG imaging in these subpopulations,” the researchers wrote.

“Cardiac sympathetic denervation as assessed with delayed 123-I MIBG SPECT imaging,” they concluded, “may improve risk stratification for arrhythmic death in patients who have an indication for ICD treatment.”

Boogers M. J Am Coll Cardiol. 2010;55:2769-2777.

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