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Cardiac ¹²³I-MIBG Uptake in Idiopathic Ventricular Tachycardia and Fibrillation

Departments of Nuclear Medicine, Cardiology and Angiology and Institute for Arteriosclerosis Research, University of Münster, Münster, Germany

Correspondence: For correspondence or reprints contact: Michael Schäfers, MD, Dept. of Nuclear Medicine, University of Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.

ABSTRACT

Patients with idiopathic ventricular tachycardia or fibrillation have no additional structural or functional myocardial abnormalities. However, the inducibility of typical tachyarrhythmias by physical or mental stress or by catecholamine infusion suggests the involvement of the adrenergic system in the pathogenesis of these potentially life-threatening diseases. Methods: 45 patients with idiopathic right ventricular outflow tract tachycardia (RVO-VT), 25 patients with idiopathic left ventricular tachycardia (ILVT), 15 patients with idiopathic ventricular fibrillation (IVF) and 10 age-matched control patients were investigated in this study. Diagnoses were made on the basis of detailed evaluation of the results of two-dimensional echocardiography, left and right ventricular angiography, coronary angiography and endomyocardial biopsy. Local presynaptic norepinephrine re-uptake was assessed using the norepinephrine analog ¹²³I-metaiodobenzylguanidine (MIBG), SPECT and semiquantitative 33-segment bull's-eye analysis. Results: Locally reduced ¹²³I-MIBG uptake was found in 27 of 45 RVO-VT patients (60%), 5 of 15 ILVT patients (33%) and 17 of 25 IVF patients (68%). Unlike ILVT patients, RVO-VT and IVF patients had significantly reduced segmental ¹²³I-MIBG uptake of the posterior wall compared with control patients. Conclusion: Patients with idiopathic tachycardia and fibrillation show abnormal ¹²³I-MIBG uptake, which indicates presynaptic sympathetic dysfunction. RVO-VT and IVF patients exhibit significantly reduced ¹²³I-MIBG uptake in the posterior left ventricular wall, whereas ILVT patients do not.

Key Words: cardiac sympathetic innervation • idiopathic ventricular tachycardia • idiopathic ventricular fibrillation • ¹²³I-metaiodobenzylguanidine SPECT

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