Author + information
- Received September 4, 2009
- Revision received November 25, 2009
- Accepted December 2, 2009
- Published online June 15, 2010.
- Mark J. Boogers, MD*,‡,
- C. Jan Willem Borleffs, MD*,
- Maureen M. Henneman, MD*,
- Rutger J. van Bommel, MD*,
- Jan van Ramshorst, MD*,
- Eric Boersma, PhD§,
- Petra Dibbets-Schneider, MSc†,
- Marcel P. Stokkel, MD, PhD†,
- Ernst E. van der Wall, MD, PhD*,
- Martin J. Schalij, MD, PhD* and
- Jeroen J. Bax, MD, PhD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
Objectives The purpose of this study was to evaluate whether 123-iodine metaiodobenzylguanidine (123-I MIBG) imaging predicts ventricular arrhythmias causing appropriate implantable cardioverter-defibrillator (ICD) therapy (primary end point) and the composite of appropriate ICD therapy or cardiac death (secondary end point).
Background Although cardiac sympathetic denervation is associated with ventricular arrhythmias, limited data are available on the predictive value of sympathetic nerve imaging with 123-I MIBG on the occurrence of arrhythmias.
Methods Before ICD implantation, patients underwent 123-I MIBG and myocardial perfusion imaging. Early and late 123-I MIBG (planar and single-photon emission computed tomography [SPECT]) imaging was performed to assess cardiac innervation (heart-to-mediastinum ratio, cardiac washout rate, and 123-I MIBG SPECT defect score). Stress-rest myocardial perfusion imaging was performed to assess myocardial infarction and perfusion abnormalities (perfusion defect scores). During follow-up, appropriate ICD therapy and cardiac death were documented.
Results One-hundred sixteen heart failure patients referred for ICD therapy were enrolled. During a mean follow-up of 23 ± 15 months, appropriate ICD therapy (primary end point) was documented in 24 (21%) patients and appropriate ICD therapy or cardiac death (secondary end point) in 32 (28%) patients. Late 123-I MIBG SPECT defect score was an independent predictor for both end points. Patients with a large late 123-I MIBG SPECT defect (summed score >26) showed significantly more appropriate ICD therapy (52% vs. 5%, p < 0.01) and appropriate ICD therapy or cardiac death (57% vs. 10%, p < 0.01) than patients with a small defect (summed score ≤26) at 3-year follow-up.
Conclusions Cardiac sympathetic denervation predicts ventricular arrhythmias causing appropriate ICD therapy as well as the composite of appropriate ICD therapy or cardiac death.
- implantable cardioverter-defibrillator
- 123-iodine metaiodobenzylguanidine imaging
- sympathetic denervation
- ventricular arrhythmias
Dr. Boogers is supported by the Dutch Heart Foundationgrant number 2006T102. Dr. Schalij received research grants from Boston Scientific, Medtronicand Biotronik. Dr. Bax received research grants from Medtronic, Boston Scientific, Biotronik, Edwards Lifesciences, BMS Medical Imaging, St. Jude Medical, and GE Healthcare.
- Received September 4, 2009.
- Revision received November 25, 2009.
- Accepted December 2, 2009.
- American College of Cardiology Foundation