Regional cardiac sympathetic denervation in patients with ventricular tachycardia in the absence of coronary artery disease

Abstract

Patients with ventricular tachycardia in the absence of coronary artery disease have abnormal cardiac sympathetic innervation detectable by cardiac sympathetic scintigraphy. The role of regional cardiac sympathetic denervation in arrhythmogenesis remains to be determined.

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

“…Cardiac 123 I-mIBG imaging is currently indicated for ''scintigraphic assessment of sympathetic innervation of the myocardium in patients with New York Heart Association [NYHA] class II or class III HF and left ventricular ejection fraction [LVEF] B35% … and to help identify patients with lower oneand two-year mortality risks, as indicated by an [HMR] ratio C1.6.'' Nevertheless, much literature suggests a potential broader use, 91 including identification of patients at increased risk of lethal cardiac arrhythmias in the setting of HF, [92][93][94][95] evaluating primary arrhythmic conditions, [96][97][98][99][100] assessing the presence and risk of ischemic heart disease, 101,102 including in situations of hibernating myocardium 103,104 and post-infarction, [105][106][107] evaluating pre-and post-cardiac transplant patients, [108][109][110] identifying diabetic patients at increased risk from cardiac autonomic dysfunction, 111,112 and monitoring toxicity from chemotherapy. 113 However, based on currently available literature, published guidelines, and the FDA package insert, the following indications can be recommended: 114 • For patients with NYHA class II or III heart failure with LVEF B35% to help stratify risk and to promote more informed clinical decision-making when the result of 123 I-mIBG study is likely to influence the decision regarding ICD implant.…”

Heterogeneous Sympathetic Innervation Influences Local Myocardial Repolarization in Normally Perfused Rabbit Hearts

“…1,2 Heterogeneity in the spatial distribution and activity of sympathetic innervation is also thought to contribute to the potential for fatal arrhythmia, possibly through effects on reentry. 3,4 Recently, several investigations have suggested a relationship between regional neuronal dysfunction and ventricular arrhythmia in humans 5,6 and animals 7,8 in the absence of infarction or perfusion abnormalities. Denervation supersensitivity to circulating catecholamines has been implicated in the pathogenesis of these arrhythmias.…”

The morpho-functional diagnostics of age-related neurodystrophic changing in the organism, which preceded sudden cardiac death

“…Как установлено кардиоло-гами в результате дискуссий на симпозиумах и в последних публикацияx, существенное значение в генезе ВСС имеет усложнение кардиологических заболеваний при наличии социального напря-жения и в процессе развития усугубляющихся возрастных нейродистрофических изменений организма [6,8,9,10,14,16,20,22,27,31,41,48,56,58,71,79,89,99].…”