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European Heart Journal 2001 22(4):323-332; doi:10.1053/euhj.2000.2482
Copyright © 2001 by the European Society of Cardiology.
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Effects of asynchronous ventricular activation on myocardial adrenergic innervation in patients with permanent dual-chamber pacemakers. An I123-metaiodobenzylguanidine cardiac scintigraphic study

E.N Simantirakisa, V.K Prassopoulosb, S.I Chrysostomakisa, G.E Kochiadakisa, S.I Koukourakib, J.P Lekakisa, N.S Karkavitsasb and P.E Vardasa,f1

a Cardiology Department, University Hospital of Heraklion, Crete, Greece
b Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece

revised September 26, 2000; accepted October 4, 2000

Abstract

Aims To evaluate myocardial sympathetic innervation abnormalities in patients with DDD pacemakers for complete heart block.

Methods We studied 39 patients, chronically paced in DDD mode because of complete atrioventricular block. Twenty-three healthy individuals served as a control group. All patients underwent planar and single-photon emission computed tomography (SPECT) myocardial imaging 4h after intravenous infusion of 185MBq I123-MIBG. The heart to mediastinum ratio was calculated to quantify cardiac I123-MIBG accumulation, while the SPECT study was performed to investigate the regional distribution of adrenergic innervation. All patients underwent a SPECT thallium201myocardial study during the same week as the I123-MIBG study.

Results The heart to mediastinum ratio was significantly smaller in paced patients than in the controls (P<0·001). 89·7% of paced patients had regional abnormalities of I123-MIBG uptake, mainly in the inferior (92·3%) and apical (38·5%) wall. 46·2% of paced patients had regional perfusion defects, also mainly in the inferior (46·2%) and apical (10·3%) wall. Neither the I123-MIBG abnormalities nor the perfusion defects were related to the duration of pacing.

Conclusions Stimulation from the apex of the right ventricle leads to regional disturbances of the adrenergic innervation of the left ventricular myocardium, as assessed by I123-MIBG activity.

Key Words: Pacing, myocardial scintigraphy, adrenergic innervation

f1 Correspondence: Prof. P. E. Vardas, MD, PhD (London), FESC, FACC, Cardiology Department, University Hospital of Heraklion, P.O. Box 1352, Stavrakia, Heraklion, Crete, Greece.

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