{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T11:32:14Z","timestamp":1740137534414,"version":"3.37.3"},"reference-count":12,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,5,16]],"date-time":"2017-05-16T00:00:00Z","timestamp":1494892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sinus bradycardia includes pathologic sick sinus syndrome (SSS) and physiologic bradycardia such as athletes\u2019 heart. Pacemaker implantation is indicated for patients with symptomatic SSS; however, the indication remains difficult to determine in those with mild and\/or unspecific symptoms. The sympathetic tone is increased in response to reduced cardiac output in SSS, whereas excessive vagal tone has been seen in physiological bradycardia. We sought to determine if cardiac iodine\u2010123\u2010metaiodobenzylguanidine scintigraphy (<jats:sup>123<\/jats:sup>I\u2010MIBG) was useful in differentiating pathologic from physiologic sinus bradycardia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty consecutive patients presenting with continuous sinus bradycardia (heart rate of &lt;50 beats\/min) in our outpatient clinic (male, eight patients; age, 70 \u00b1 12 years old) were enrolled. The indication for a pacemaker implantation was determined by an experienced electrophysiologist in compliance with the international guidelines. The sympathetic nervous tone was assessed by cardiac<jats:sup>123<\/jats:sup>I\u2010MIBG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eight patients (40%) were clinically diagnosed as SSS (type I) including four suffering from obvious symptoms (syncope or dizziness) and four suffering from mild symptoms (fatigue), and had an indication for a pacemaker implantation. The patients with SSS indicated for a pacemaker implantation had a lower early heart\u2010to\u2010mediastinum ratio (2.0 \u00b1 0.6 vs 2.5 \u00b1 0.2, P = 0.043), lower delayed heart to mediastinum ratio (2.0 \u00b1 0.8 vs 2.8 \u00b1 0.3, P = 0.026), and higher washout rate (34 \u00b1 6.0 vs 26 \u00b1 6.0, P = 0.008) than those without.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Excessive sympathetic tone detected by<jats:sup>123<\/jats:sup>I\u2010MIBG may serve as an adjunct to determine the indication for a pacemaker implantation in sinus bradycardia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13078","type":"journal-article","created":{"date-parts":[[2017,3,27]],"date-time":"2017-03-27T08:30:12Z","timestamp":1490603412000},"page":"632-637","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac iodine\u2010123\u2010metaiodobenzylguanidine scintigraphy may be useful to identify pathologic from physiologic sinus bradycardia"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2590-6696","authenticated-orcid":false,"given":"Akihiro","family":"Sunaga","sequence":"first","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5566-466X","authenticated-orcid":false,"given":"Masaharu","family":"Masuda","sequence":"additional","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Fujita","sequence":"additional","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osamu","family":"Iida","sequence":"additional","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kanda","sequence":"additional","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiro","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takakazu","family":"Morozumi","sequence":"additional","affiliation":[{"name":"Ohara Internal medicine and cardiology Clinic Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Mano","sequence":"additional","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaaki","family":"Uematsu","sequence":"additional","affiliation":[{"name":"Kansai Rosai Hospital Cardiovascular Center Hyogo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,5,16]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"22","article-title":"Myocardial imaging with a radioiodinated norepinephrine storage analog","volume":"22","author":"Wieland DM","year":"1981","journal-title":"J Nucl Med"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1364024"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01111.2014"},{"key":"e_1_2_8_5_1","first-page":"129","article-title":"Myocardial imaging in man with I\u2010123 meta\u2010iodobenzylguanidine","volume":"22","author":"Kline RC","year":"1981","journal-title":"J Nucl 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