Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1993 Jan;69(1):6–13. doi: 10.1136/hrt.69.1.6

Asymmetry of cardiac [123I] meta-iodobenzyl-guanidine scans in patients with ventricular tachycardia and a "clinically normal" heart.

J S Gill 1, G J Hunter 1, J Gane 1, D E Ward 1, A J Camm 1
PMCID: PMC1024908  PMID: 8457398

Abstract

OBJECTIVE--Patients with exercise induced ventricular tachycardia associated with a "clinically normal" heart may have an abnormality of the regional distribution of the cardiac sympathetic nerve supply. In this study the regional distribution of the myocardial nerve supply in patients with ventricular tachycardia (VT) and control subjects was examined by [123] meta-iodobenzylguanidine (MIBG) scanning. PATIENTS AND DESIGN--Eight patients with exercise induced VT and seven patients with VT unrelated to exercise with "clinically normal" hearts were studied and compared with a control group of six subjects with atrioventricular reentrant tachycardia not related to exercise and eight patients with angiographically normal left ventricular function and normal coronary anatomy who had thallium scans without evidence of ischaemia or fixed perfusion deficits. METHODS--Single photon emission computed tomography gamma scanning was performed in patients three hours after intravenous injection of MIBG. The left ventricular MIBG uptake data was processed into bull's-eye target plots. The inferior portion of the scan frequently showed artefact due to uptake of MIBG in the liver or spleen and was not used for statistical analysis. Asymmetry of uptake was defined as a ratio of uptake exceeding 1.25 in the upper quadrants (posterior (anterolateral free wall)/anterior (anteroseptal region)) of the MIBG scan. RESULTS--Patients with VT had a higher proportion of asymmetrical MIBG scans (47%) than subjects in the control groups (0%) and this was particularly obvious in the patients with exercise induced VT (62.5%). This suggests that patients with VT may have relative denervation in the septal portion of the left ventricle leading to an imbalance of the sympathetic supply to the myocardium and locally imbalanced sympathetic or parasympathetic interactions. Considerable evidence from animal experiments suggests that imbalance of the sympathetic supply to the myocardium is important in the genesis of ventricular arrhythmia. CONCLUSIONS--These results support the hypothesis that selective denervation of the human myocardium may be an important mechanism in the genesis of VT in "clinically normal" hearts.

Full text

PDF
6

Images in this article

8Image
on p.8
10Image
on p.10
10Image
on p.10

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ARMBRUST C. A., Jr, LEVINE S. A. Paroxysmal ventricular tachycardia; a study of 107 cases. Circulation. 1950 Jan;1(1):28–40. doi: 10.1161/01.cir.1.1.28. [DOI] [PubMed] [Google Scholar]
  2. ARMBRUST C. A., Jr, LEVINE S. A. Paroxysmal ventricular tachycardia; a study of 107 cases. Circulation. 1950 Jan;1(1):28–40. doi: 10.1161/01.cir.1.1.28. [DOI] [PubMed] [Google Scholar]
  3. Abramson F. B., Furst C. I., McMartin C., Wade R. The isolation, identification and synthesis of two metabolites of guanethidine formed in pig and rabbit liver homogenates. Biochem J. 1969 Jun;113(1):143–156. doi: 10.1042/bj1130143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Abramson F. B., Furst C. I., McMartin C., Wade R. The isolation, identification and synthesis of two metabolites of guanethidine formed in pig and rabbit liver homogenates. Biochem J. 1969 Jun;113(1):143–156. doi: 10.1042/bj1130143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bhagat B. D., Rao P. S., Dhalla N. S. Role of catecholamines in the genesis of arrhythmias. Adv Myocardiol. 1980;2:117–132. [PubMed] [Google Scholar]
  6. Bruce R. A., Hornsten T. R. Exercise stress testing in evaluation of patients with ischemic heart disease. Prog Cardiovasc Dis. 1969 Mar;11(5):371–390. doi: 10.1016/0033-0620(69)90027-9. [DOI] [PubMed] [Google Scholar]
  7. Buxton A. E., Waxman H. L., Marchlinski F. E., Simson M. B., Cassidy D., Josephson M. E. Right ventricular tachycardia: clinical and electrophysiologic characteristics. Circulation. 1983 Nov;68(5):917–927. doi: 10.1161/01.cir.68.5.917. [DOI] [PubMed] [Google Scholar]
  8. Cameron J. S., Han J. Effects of epinephrine on automaticity and the incidence of arrhythmias in Purkinje fibers surviving myocardial infarction. J Pharmacol Exp Ther. 1982 Nov;223(2):573–579. [PubMed] [Google Scholar]
  9. Chapman J. H., Schrank J. P., Crampton R. S. Idiopathic ventricular tachycardia. An intracardiac electrical, hemodynamic and angiographic assessment of six patients. Am J Med. 1975 Oct;59(4):470–480. doi: 10.1016/0002-9343(75)90254-5. [DOI] [PubMed] [Google Scholar]
  10. Dae M. W., O'Connell J. W., Botvinick E. H., Ahearn T., Yee E., Huberty J. P., Mori H., Chin M. C., Hattner R. S., Herre J. M. Scintigraphic assessment of regional cardiac adrenergic innervation. Circulation. 1989 Mar;79(3):634–644. doi: 10.1161/01.cir.79.3.634. [DOI] [PubMed] [Google Scholar]
  11. Dae M. W., O'Connell J. W., Botvinick E. H., Ahearn T., Yee E., Huberty J. P., Mori H., Chin M. C., Hattner R. S., Herre J. M. Scintigraphic assessment of regional cardiac adrenergic innervation. Circulation. 1989 Mar;79(3):634–644. doi: 10.1161/01.cir.79.3.634. [DOI] [PubMed] [Google Scholar]
  12. Deal B. J., Miller S. M., Scagliotti D., Prechel D., Gallastegui J. L., Hariman R. J. Ventricular tachycardia in a young population without overt heart disease. Circulation. 1986 Jun;73(6):1111–1118. doi: 10.1161/01.cir.73.6.1111. [DOI] [PubMed] [Google Scholar]
  13. FROMENT R., GALLAVARDIN L., CAHEN P. Paroxysmal ventricular tachycardia; a clinical classification. Br Heart J. 1953 Apr;15(2):172–178. doi: 10.1136/hrt.15.2.172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Gardner P. I., Ursell P. C., Fenoglio J. J., Jr, Wit A. L. Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation. 1985 Sep;72(3):596–611. doi: 10.1161/01.cir.72.3.596. [DOI] [PubMed] [Google Scholar]
  15. Hockman C. H., Mauck H. P., Jr, Hoff E. C. ECG changes resulting from cerebral stimulation. II. A spectrum of ventricular arrhythmias of sympathetic origin. Am Heart J. 1966 May;71(5):695–700. doi: 10.1016/0002-8703(66)90322-x. [DOI] [PubMed] [Google Scholar]
  16. Josephson M. E., Horowitz L. N., Farshidi A. Continuous local electrical activity. A mechanism of recurrent ventricular tachycardia. Circulation. 1978 Apr;57(4):659–665. doi: 10.1161/01.cir.57.4.659. [DOI] [PubMed] [Google Scholar]
  17. Kimura S., Bassett A. L., Kohya T., Kozlovskis P. L., Myerburg R. J. Automaticity, triggered activity, and responses to adrenergic stimulation in cat subendocardial Purkinje fibers after healing of myocardial infarction. Circulation. 1987 Mar;75(3):651–660. doi: 10.1161/01.cir.75.3.651. [DOI] [PubMed] [Google Scholar]
  18. Kliks B. R., Burgess M. J., Abildskov J. A. Influence of sympathetic tone on ventricular fibrillation threshold during experimental coronary occlusion. Am J Cardiol. 1975 Jul;36(1):45–49. doi: 10.1016/0002-9149(75)90866-8. [DOI] [PubMed] [Google Scholar]
  19. Kline R. C., Swanson D. P., Wieland D. M., Thrall J. H., Gross M. D., Pitt B., Beierwaltes W. H. Myocardial imaging in man with I-123 meta-iodobenzylguanidine. J Nucl Med. 1981 Feb;22(2):129–132. [PubMed] [Google Scholar]
  20. Kline R. C., Swanson D. P., Wieland D. M., Thrall J. H., Gross M. D., Pitt B., Beierwaltes W. H. Myocardial imaging in man with I-123 meta-iodobenzylguanidine. J Nucl Med. 1981 Feb;22(2):129–132. [PubMed] [Google Scholar]
  21. Lazzara R., el-Sherif N., Scherlag B. J. Electrophysiological properties of canine Purkinje cells in one-day-old myocardial infarction. Circ Res. 1973 Dec;33(6):722–734. doi: 10.1161/01.res.33.6.722. [DOI] [PubMed] [Google Scholar]
  22. Lemery R., Brugada P., Bella P. D., Dugernier T., van den Dool A., Wellens H. J. Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. Circulation. 1989 May;79(5):990–999. doi: 10.1161/01.cir.79.5.990. [DOI] [PubMed] [Google Scholar]
  23. MELVILLE K. I., BLUM B., SHISTER H. E., SILVER M. D. CARDIAC ISCHEMIC CHANGES AND ARRHYTHMIAS INDUCED BY HYPOTHALAMIC STIMULATION. Am J Cardiol. 1963 Dec;12:781–791. doi: 10.1016/0002-9149(63)90281-9. [DOI] [PubMed] [Google Scholar]
  24. Martins J. B. Autonomic control of ventricular tachycardia: sympathetic neural influence on spontaneous tachycardia 24 hours after coronary occlusion. Circulation. 1985 Oct;72(4):933–942. doi: 10.1161/01.cir.72.4.933. [DOI] [PubMed] [Google Scholar]
  25. Mehta D., McKenna W. J., Ward D. E., Davies M. J., Camm A. J. Significance of signal-averaged electrocardiography in relation to endomyocardial biopsy and ventricular stimulation studies in patients with ventricular tachycardia without clinically apparent heart disease. J Am Coll Cardiol. 1989 Aug;14(2):372–381. doi: 10.1016/0735-1097(89)90188-5. [DOI] [PubMed] [Google Scholar]
  26. Mehta D., Odawara H., Ward D. E., McKenna W. J., Davies M. J., Camm A. J. Echocardiographic and histologic evaluation of the right ventricle in ventricular tachycardias of left bundle branch block morphology without overt cardiac abnormality. Am J Cardiol. 1989 Apr 15;63(13):939–944. doi: 10.1016/0002-9149(89)90144-6. [DOI] [PubMed] [Google Scholar]
  27. Nakajo M., Shimabukuro K., Yoshimura H., Yonekura R., Nakabeppu Y., Tanoue P., Shinohara S. Iodine-131 metaiodobenzylguanidine intra- and extravesicular accumulation in the rat heart. J Nucl Med. 1986 Jan;27(1):84–89. [PubMed] [Google Scholar]
  28. Nakajo M., Shimabukuro K., Yoshimura H., Yonekura R., Nakabeppu Y., Tanoue P., Shinohara S. Iodine-131 metaiodobenzylguanidine intra- and extravesicular accumulation in the rat heart. J Nucl Med. 1986 Jan;27(1):84–89. [PubMed] [Google Scholar]
  29. Otto C. A., Brown L. E., Scott A. M. Radioiodinated branched-chain fatty acids: substrates for beta oxidation? Concise communication. J Nucl Med. 1984 Jan;25(1):75–80. [PubMed] [Google Scholar]
  30. Palileo E. V., Ashley W. W., Swiryn S., Bauernfeind R. A., Strasberg B., Petropoulos A. T., Rosen K. M. Exercise provocable right ventricular outflow tract tachycardia. Am Heart J. 1982 Aug;104(2 Pt 1):185–193. doi: 10.1016/0002-8703(82)90190-9. [DOI] [PubMed] [Google Scholar]
  31. Priori S. G., Mantica M., Schwartz P. J. Delayed afterdepolarizations elicited in vivo by left stellate ganglion stimulation. Circulation. 1988 Jul;78(1):178–185. doi: 10.1161/01.cir.78.1.178. [DOI] [PubMed] [Google Scholar]
  32. Schwartz P. J., Snebold N. G., Brown A. M. Effects of unilateral cardiac sympathetic denervation on the ventricular fibrillation threshold. Am J Cardiol. 1976 Jun;37(7):1034–1040. doi: 10.1016/0002-9149(76)90420-3. [DOI] [PubMed] [Google Scholar]
  33. Schwartz P. J., Stone H. L., Brown A. M. Effects of unilateral stellate ganglion blockade on the arrhythmias associated with coronary occlusion. Am Heart J. 1976 Nov;92(5):589–599. doi: 10.1016/s0002-8703(76)80078-6. [DOI] [PubMed] [Google Scholar]
  34. Schwartz P. J., Stone H. L. Effects of unilateral stellectomy upon cardiac performance during exercise in dogs. Circ Res. 1979 May;44(5):637–645. doi: 10.1161/01.res.44.5.637. [DOI] [PubMed] [Google Scholar]
  35. Schwartz P. J., Verrier R. L., Lown B. Effect of stellectomy and vagotomy on ventricular refractoriness in dogs. Circ Res. 1977 Jun;40(6):536–540. doi: 10.1161/01.res.40.6.536. [DOI] [PubMed] [Google Scholar]
  36. Sisson J. C., Lynch J. J., Johnson J., Jaques S., Jr, Wu D., Bolgos G., Lucchesi B. R., Wieland D. M. Scintigraphic detection of regional disruption of adrenergic neurons in the heart. Am Heart J. 1988 Jul;116(1 Pt 1):67–76. doi: 10.1016/0002-8703(88)90251-7. [DOI] [PubMed] [Google Scholar]
  37. Sisson J. C., Lynch J. J., Johnson J., Jaques S., Jr, Wu D., Bolgos G., Lucchesi B. R., Wieland D. M. Scintigraphic detection of regional disruption of adrenergic neurons in the heart. Am Heart J. 1988 Jul;116(1 Pt 1):67–76. doi: 10.1016/0002-8703(88)90251-7. [DOI] [PubMed] [Google Scholar]
  38. Verrier R. L., Thompson P. L., Lown B. Ventricular vulnerability during sympathetic stimulation: role of heart rate and blood pressure. Cardiovasc Res. 1974 Sep;8(5):602–610. doi: 10.1093/cvr/8.5.602. [DOI] [PubMed] [Google Scholar]
  39. Wellens H. J., Brugada P., Stevenson W. G. Programmed electrical stimulation of the heart in patients with life-threatening ventricular arrhythmias: what is the significance of induced arrhythmias and what is the correct stimulation protocol? Circulation. 1985 Jul;72(1):1–7. doi: 10.1161/01.cir.72.1.1. [DOI] [PubMed] [Google Scholar]
  40. Wieland D. M., Brown L. E., Rogers W. L., Worthington K. C., Wu J. L., Clinthorne N. H., Otto C. A., Swanson D. P., Beierwaltes W. H. Myocardial imaging with a radioiodinated norepinephrine storage analog. J Nucl Med. 1981 Jan;22(1):22–31. [PubMed] [Google Scholar]
  41. Wieland D. M., Wu J., Brown L. E., Mangner T. J., Swanson D. P., Beierwaltes W. H. Radiolabeled adrenergi neuron-blocking agents: adrenomedullary imaging with [131I]iodobenzylguanidine. J Nucl Med. 1980 Apr;21(4):349–353. [PubMed] [Google Scholar]
  42. Wieland D. M., Wu J., Brown L. E., Mangner T. J., Swanson D. P., Beierwaltes W. H. Radiolabeled adrenergi neuron-blocking agents: adrenomedullary imaging with [131I]iodobenzylguanidine. J Nucl Med. 1980 Apr;21(4):349–353. [PubMed] [Google Scholar]
  43. Wit A. L., Cranefield P. F. Triggered activity in cardiac muscle fibers of the simian mitral valve. Circ Res. 1976 Feb;38(2):85–98. doi: 10.1161/01.res.38.2.85. [DOI] [PubMed] [Google Scholar]
  44. le Marec H., Dangman K. H., Danilo P., Jr, Rosen M. R. An evaluation of automaticity and triggered activity in the canine heart one to four days after myocardial infarction. Circulation. 1985 Jun;71(6):1224–1236. doi: 10.1161/01.cir.71.6.1224. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES