| 김동희, 신동구, 조인호 ¹, 손장원, 강상욱, 김웅, 이상희, 홍그루, 박종선, 김영조, 심봉섭 |
Background and Objectives: Premature ventricular complex(PVC) is one of the most common arrhythmia encountered in clinic and an important factor for the genesis of life threatening ventricular arrhythmia in cardiac diseases. However, the pathophysiology of PVC is not well understood. The object of this study is to evaluate relationship between cardiac sympathetic nerve activity by using MIBG and PVC in patients with structurally normal heart. Methods: Thirty-four patients(12 men, mean age 61.6±12.8 years) with echocardiography proven structurally normal heart were studied and divided into 2 groups with Holter monitor documented PVC(group A; 22 patients ) and without PVC(group B; 12 patients). Echocardiography, 24-hour Holter monitoring and 123I-MIBG were performed in all patients. The early(15min) and delayed(3hours) uptake, heart to mediastinum uptake(H/M) ratio, global washout ratio(WOR:defined as [early H -delayed H]/early HX100) were measured on 123I-MIBG. Polar map of LV myocardium were divided into 5 segment(anterior, septum, lateral, inferior and apex) and calculated regional uptake and WOR. The clinical variables, echocardiographic parameters and 123I-MIBG derived parameters were compared between the 2 groups. Results: Average of PVC count was 5,198/day in group A patients. There were no significant difference in age, LVEF(60.4±8.6% vs 61.4±9.7%, p=NS), LVESD and LVEDD between the 2 groups. Group A patients had higher early(2.75±0.36 vs 2.62±0.61, ρ=0.349), delayed H/M ratio(2.64±0.47 vs 2.27±0.57, ρ=0.130) and lower average WOR than that of group B(0.24±0.11 vs 0.27±0.11, ρ=0.407), though the difference was not statistically significant. The delayed inferior wall H/M ratio increased significantly in group A( 2.69±0.45 vs 2.26±0.54, ρ=0.044), and early inferior wall H/M ratio has a tendency to be higher in group A(2.81±0.37 vs 2.62±0.63, ρ=0.087). Conclusion: The occurrence of PVC in structurally normal heart may be related to increased cardiac sympathetic nerve innervation, especially of inferior wall. These results might partially explain the role of sympathetic nervous system in the genesis of PVC.
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