RESYNCHRONISATION THERAPY
Improvement in cardiac sympathetic nerve activity in responders to resynchronization therapy
1 Cardiology Service, University Hospital of Geneva, 23, Micheli-du-Crest, 1211 Geneva, Switzerland; 2 Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
Aims: To assess changes in cardiac adrenergic activity with cardiac resynchronization therapy (CRT), and to investigate whether these changes are related to improvement in left ventricular ejection fraction (LVEF).
Methods and results: Sixteen patients (13 males, age 66 ± 7 years) were studied at baseline and after 
6 months of CRT (mean follow-up 9.2 ± 3.2 months). LVEF was assessed by nuclear angiography. Responders were defined as patients showing 5% absolute increase in LVEF + improvement in 1 NYHA class + absence of heart failure hospitalization. Cardiac sympathetic nerve activity was studied by 123I-metaiodobenzyl-guanidine (123I-MIBG) scintigraphy. Responders (n = 8) showed lower 123I-MIBG washout at follow-up when compared with non-responders (P = 0.002), indicating lower cardiac sympathetic nerve activity. The decrease in 123I-MIBG washout at follow-up when compared with baseline was only seen in the responder group (P = 0.036). There was a moderate correlation between increase in LVEF and decrease in 123I-MIBG washout (r = 0.52, P = 0.04).
Conclusion: CRT induces a reduction in cardiac sympathetic nerve activity in responders, that parallels an improvement in LVEF, whereas non-responders do not show any significant changes.
Key Words: Cardiac resynchronization therapy, MIBG, Nervous system, Sympathetic, Ventricular function
* Corresponding author. Tel: +41 22 372 72 00; fax: +41 22 372 72 29. E-mail address: haran.burri{at}hcuge.ch
Manuscript submitted 9 November 2007. Accepted after revision 8 January 2008.
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