I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defribillator

Rishi Arora, Kevin J. Ferrick, Tomoaki Nakata, Robert C. Kaplan, Michael Rozengarten, Farhana Latif, Kaman Ng, Vanessa Marcano, Sherman Heller, John Devens Fisher, Mark I. Travin

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

Background. Iodine 123 metaiodobenzylguanidine (MIBG) imaging and heart rate variability (HRV) analysis were compared in patients with an implantable cardioverter defibrillator (ICD) who did and did not receive defibrillator discharges. Although the ICD has been shown to abort potentially fatal ventricular arrhythmias, identification of patients who most benefit from this device remains difficult. As the autonomic nervous system has been implicated in the genesis of these arrhythmias, we undertook a pilot study to evaluate local myocardial sympathetic innervation with the use of I-123 MIBG myocardial imaging, as well as central autonomic tone with the use of HRV, in patients with implantable defibrillators. Test results were correlated with the occurrence of ICD discharges. Methods and results. Seventeen patients with previously implanted defibrillators were studied. Of these, 10 had at least 1 appropriate device discharge for ventricular tachyarrhythmias, whereas 7 had no discharge. Patients with a discharge had a significantly lower I-123 MIBG heart-mediastinal tracer uptake ratio, higher I-123 MIBG defect scores, more extensive sympathetic denervation, and significantly reduced values for several HRV parameters, particularly those in the frequency domain. When combined, the I-123 MIBG heart-mediastinal ratio and HRV 5-minute low-frequency variables were highly predictive of defibrillator discharges. All patients with a heart-mediastinal ratio lower than 1.54 and 5-minute low frequency lower than 443 ms2 had an ICD discharge (4/4), whereas no patient with an uptake ratio greater than 1.54 and 5-minute low frequency greater than 443 ms2 did (0/3, P = .03). Conclusions. Cardiac autonomic assessment using a combination of myocardial scintigraphic and neurophysiologic techniques may help select patients who would most benefit from an implantable defibrillator by identifying those at increased risk for potentially fatal arrhythmias.

Original languageEnglish (US)
Pages (from-to)121-131
Number of pages11
JournalJournal of Nuclear Cardiology
Volume10
Issue number2
DOIs
StatePublished - Mar 2003

Fingerprint

Implantable Defibrillators
Heart Rate
Defibrillators
Cardiac Arrhythmias
Equipment and Supplies
Sympathectomy
Autonomic Nervous System
Tachycardia
Iodine

Keywords

  • Heart rate variability
  • Implantable cardioverter defibrillator
  • Iodine 123 metaiodobenzylyguanidine imaging
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defribillator. / Arora, Rishi; Ferrick, Kevin J.; Nakata, Tomoaki; Kaplan, Robert C.; Rozengarten, Michael; Latif, Farhana; Ng, Kaman; Marcano, Vanessa; Heller, Sherman; Fisher, John Devens; Travin, Mark I.

In: Journal of Nuclear Cardiology, Vol. 10, No. 2, 03.2003, p. 121-131.

Research output: Contribution to journalArticle

Arora, Rishi ; Ferrick, Kevin J. ; Nakata, Tomoaki ; Kaplan, Robert C. ; Rozengarten, Michael ; Latif, Farhana ; Ng, Kaman ; Marcano, Vanessa ; Heller, Sherman ; Fisher, John Devens ; Travin, Mark I. / I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defribillator. In: Journal of Nuclear Cardiology. 2003 ; Vol. 10, No. 2. pp. 121-131.
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abstract = "Background. Iodine 123 metaiodobenzylguanidine (MIBG) imaging and heart rate variability (HRV) analysis were compared in patients with an implantable cardioverter defibrillator (ICD) who did and did not receive defibrillator discharges. Although the ICD has been shown to abort potentially fatal ventricular arrhythmias, identification of patients who most benefit from this device remains difficult. As the autonomic nervous system has been implicated in the genesis of these arrhythmias, we undertook a pilot study to evaluate local myocardial sympathetic innervation with the use of I-123 MIBG myocardial imaging, as well as central autonomic tone with the use of HRV, in patients with implantable defibrillators. Test results were correlated with the occurrence of ICD discharges. Methods and results. Seventeen patients with previously implanted defibrillators were studied. Of these, 10 had at least 1 appropriate device discharge for ventricular tachyarrhythmias, whereas 7 had no discharge. Patients with a discharge had a significantly lower I-123 MIBG heart-mediastinal tracer uptake ratio, higher I-123 MIBG defect scores, more extensive sympathetic denervation, and significantly reduced values for several HRV parameters, particularly those in the frequency domain. When combined, the I-123 MIBG heart-mediastinal ratio and HRV 5-minute low-frequency variables were highly predictive of defibrillator discharges. All patients with a heart-mediastinal ratio lower than 1.54 and 5-minute low frequency lower than 443 ms2 had an ICD discharge (4/4), whereas no patient with an uptake ratio greater than 1.54 and 5-minute low frequency greater than 443 ms2 did (0/3, P = .03). Conclusions. Cardiac autonomic assessment using a combination of myocardial scintigraphic and neurophysiologic techniques may help select patients who would most benefit from an implantable defibrillator by identifying those at increased risk for potentially fatal arrhythmias.",
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AU - Arora, Rishi

AU - Ferrick, Kevin J.

AU - Nakata, Tomoaki

AU - Kaplan, Robert C.

AU - Rozengarten, Michael

AU - Latif, Farhana

AU - Ng, Kaman

AU - Marcano, Vanessa

AU - Heller, Sherman

AU - Fisher, John Devens

AU - Travin, Mark I.

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N2 - Background. Iodine 123 metaiodobenzylguanidine (MIBG) imaging and heart rate variability (HRV) analysis were compared in patients with an implantable cardioverter defibrillator (ICD) who did and did not receive defibrillator discharges. Although the ICD has been shown to abort potentially fatal ventricular arrhythmias, identification of patients who most benefit from this device remains difficult. As the autonomic nervous system has been implicated in the genesis of these arrhythmias, we undertook a pilot study to evaluate local myocardial sympathetic innervation with the use of I-123 MIBG myocardial imaging, as well as central autonomic tone with the use of HRV, in patients with implantable defibrillators. Test results were correlated with the occurrence of ICD discharges. Methods and results. Seventeen patients with previously implanted defibrillators were studied. Of these, 10 had at least 1 appropriate device discharge for ventricular tachyarrhythmias, whereas 7 had no discharge. Patients with a discharge had a significantly lower I-123 MIBG heart-mediastinal tracer uptake ratio, higher I-123 MIBG defect scores, more extensive sympathetic denervation, and significantly reduced values for several HRV parameters, particularly those in the frequency domain. When combined, the I-123 MIBG heart-mediastinal ratio and HRV 5-minute low-frequency variables were highly predictive of defibrillator discharges. All patients with a heart-mediastinal ratio lower than 1.54 and 5-minute low frequency lower than 443 ms2 had an ICD discharge (4/4), whereas no patient with an uptake ratio greater than 1.54 and 5-minute low frequency greater than 443 ms2 did (0/3, P = .03). Conclusions. Cardiac autonomic assessment using a combination of myocardial scintigraphic and neurophysiologic techniques may help select patients who would most benefit from an implantable defibrillator by identifying those at increased risk for potentially fatal arrhythmias.

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KW - Implantable cardioverter defibrillator

KW - Iodine 123 metaiodobenzylyguanidine imaging

KW - Sudden cardiac death

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