title: I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defibrillator.
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.
  
  
  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 ms(2) 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 ms(2) 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.
authors.affiliation: Division of Cardiology and Department of Nuclear Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Rishi
authors.initials: R
authors.lastname: Arora
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Ferrick
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakata
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.forename: Michael
authors.initials: M
authors.lastname: Rozengarten
authors.forename: Farhana
authors.initials: F
authors.lastname: Latif
authors.forename: Kaman
authors.initials: K
authors.lastname: Ng
authors.forename: Vanessa
authors.initials: V
authors.lastname: Marcano
authors.forename: Sherman
authors.initials: S
authors.lastname: Heller
authors.forename: John D
authors.initials: JD
authors.lastname: Fisher
authors.forename: Mark I
authors.initials: MI
authors.lastname: Travin
mesh_terms: D019797:3-Iodobenzylguanidine; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D018579:Patient Selection; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods; D013223:Statistics as Topic; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine