Circulation, Vol 88, 172-179, Copyright © 1993 by American Heart Association
H Calkins, K Allman, S Bolling, M Kirsch, D Wieland, F Morady and M Schwaiger
BACKGROUND. Denervation supersensitivity has been proposed as a mechanism
for the relation between ventricular arrhythmias and the sympathetic
nervous system. Evaluation of this phenomenon in humans has become feasible
only recently with the development of noninvasive scintigraphic methods for
evaluating the pattern of sympathetic innervation. The purpose of this
study was to determine if scintigraphic evidence of sympathetic neuronal
dysfunction correlates with measurements of ventricular refractoriness and
to evaluate the phenomenon of denervation supersensitivity in humans.
METHODS AND RESULTS. Eleven patients with a history of sustained
ventricular tachycardia or sudden cardiac death who were referred for
placement of an implantable defibrillator participated in this study (seven
men and four women; age, 51 +/- 18 years). Preoperative scintigraphic
evaluation of the pattern of sympathetic innervation was performed with
11C-hydroxyephedrine in conjunction with positron emission tomography. At
the time of surgery, ventricular refractoriness was determined in regions
of myocardium demonstrating normal and reduced 11C- hydroxyephedrine
retention in the baseline state and during an infusion of norepinephrine.
Scintigraphic evaluation demonstrated regions of reduced
11C-hydroxyephedrine retention in each patient. The effective refractory
period in areas of myocardium that demonstrated reduced 11C-
hydroxyephedrine retention was significantly longer than in areas of
myocardium demonstrating normal 11C-hydroxyephedrine retention (273 +/- 32
versus 243 +/- 32 msec, p < 0.001). Norepinephrine shortened the
effective refractory period in regions of myocardium demonstrating normal
and reduced 11C-hydroxyephedrine retention to a similar degree.
CONCLUSIONS. There is a correlation between scintigraphic evidence of
sympathetic neuronal dysfunction and ventricular refractoriness in the
human heart. These observations help validate the use of scintigraphic
techniques for evaluation of sympathetic innervation and may assist in the
further evaluation of the relation between the sympathetic nervous system
and ventricular arrhythmias.
ARTICLES
Correlation between scintigraphic evidence of regional sympathetic neuronal dysfunction and ventricular refractoriness in the human heart
University of Michigan Medical Division of Cardiology, Ann Arbor.
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