{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:15:14Z","timestamp":1760832914957,"version":"build-2065373602"},"reference-count":25,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[2002,9]]},"abstract":"<jats:p>\n                  <jats:bold>Objective:<\/jats:bold> To investigate ventricular sympathetic innervation in patients with sick sinus syndrome and to detect regional deterioration of adrenergic innervation caused by asynchronous ventricular activation from right ventricular pacing.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Design:<\/jats:bold> Prospective controlled study.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Setting:<\/jats:bold> Tertiary cardiac referral centre.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Patients:<\/jats:bold> 22 patients with sick sinus syndrome and indications for permanent dual chamber pacing; 20 healthy individuals as controls.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Interventions:<\/jats:bold> All patients underwent myocardial imaging with planar and single photon emission computed tomography (SPECT) after an intravenous infusion of 5 mCi <jats:sup>123<\/jats:sup>I-meta-iodobenzylguanidine (<jats:sup>123<\/jats:sup>I-MIBG) before and after pacemaker implantation. A SPECT thallium<jats:sup>201<\/jats:sup> myocardial study was done during the same week as the <jats:sup>123<\/jats:sup>I-MIBG study in all patients.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Main outcome measures:<\/jats:bold> The heart to mediastinum (H\/M) ratio and washout rate were calculated during the <jats:sup>123<\/jats:sup>I-MIBG study to assess the global cardiac sympathetic activity; the aim of the SPECT study was to investigate the regional distribution of adrenergic innervation.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Results:<\/jats:bold> The H\/M ratio was significantly smaller in the patients with sick sinus syndrome than in the controls (p &lt; 0.001). In sick sinus syndrome there were regional adrenergic innervation defects, mostly in the inferior and apical walls. After a medium term pacing period, a redistribution of <jats:sup>123<\/jats:sup>I-MIBG uptake was detected, with deterioration of adrenergic innervation in the inferior, apical, and posterior walls. The thallium<jats:sup>201<\/jats:sup> myocardial perfusion study showed no change after three months of permanent pacing.<\/jats:p>\n               <jats:p>\n                  <jats:bold>Conclusions:<\/jats:bold> Patients with sick sinus syndrome have global and regional disturbances of the adrenergic innervation of the left ventricular myocardium. These seem to deteriorate as a result of asynchronous electrical activation. The clinical significance of this finding requires further investigation.<\/jats:p>","DOI":"10.1136\/heart.88.3.255","type":"journal-article","created":{"date-parts":[[2002,10,1]],"date-time":"2002-10-01T15:54:10Z","timestamp":1033487650000},"page":"255-259","source":"Crossref","is-referenced-by-count":11,"title":["Assessment of myocardial adrenergic innervation in patients with sick sinus syndrome: effect of asynchronous ventricular activation from ventricular apical stimulation"],"prefix":"10.1136","volume":"88","author":[{"given":"M E","family":"Marketou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E N","family":"Simantirakis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V K","family":"Prassopoulos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S I","family":"Chrysostomakis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A A","family":"Velidaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N S","family":"Karkavitsas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P E","family":"Vardas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2002,9,1]]},"reference":[{"key":"2025101723064388000_88.3.255.1","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S0735-1097(87)80215-2","volume":"10","year":"1987","journal-title":"J Am Coll Cardiol"},{"key":"2025101723064388000_88.3.255.2","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1111\/j.1540-8159.1996.tb04205.x","volume":"19","year":"1996","journal-title":"PACE"},{"key":"2025101723064388000_88.3.255.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90691-X"},{"key":"2025101723064388000_88.3.255.4","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(86)90682-4"},{"key":"2025101723064388000_88.3.255.5","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(91)90195-N"},{"key":"2025101723064388000_88.3.255.6","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/S0002-8703(05)80237-6","volume":"119","year":"1990","journal-title":"Am Heart J"},{"key":"2025101723064388000_88.3.255.7","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(95)90356-9"},{"key":"2025101723064388000_88.3.255.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00586-4"},{"key":"2025101723064388000_88.3.255.9","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2000.2482"},{"key":"2025101723064388000_88.3.255.10","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1161\/01.CIR.79.3.634","volume":"79","year":"1989","journal-title":"Circulation"},{"key":"2025101723064388000_88.3.255.11","first-page":"471","volume":"33","year":"1992","journal-title":"J Nucl Med"},{"key":"2025101723064388000_88.3.255.12","first-page":"1321","volume":"31","year":"1994","journal-title":"Kaku Igaku"},{"key":"2025101723064388000_88.3.255.13","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(64)90033-5"},{"key":"2025101723064388000_88.3.255.14","first-page":"H300","volume":"259","year":"1990","journal-title":"Am J Physiol"},{"key":"2025101723064388000_88.3.255.15","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.6.588"},{"key":"2025101723064388000_88.3.255.16","doi-asserted-by":"publisher","DOI":"10.1016\/S1071-3581(99)90063-6"},{"key":"2025101723064388000_88.3.255.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)00593-3"},{"key":"2025101723064388000_88.3.255.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)01096-2"},{"key":"2025101723064388000_88.3.255.19","doi-asserted-by":"publisher","DOI":"10.1097\/00006231-200003000-00014"},{"key":"2025101723064388000_88.3.255.20","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90567-3"},{"key":"2025101723064388000_88.3.255.21","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1536\/ihj.36.583","volume":"36","year":"1995","journal-title":"Jpn Heart J"},{"key":"2025101723064388000_88.3.255.22","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.9.1060"},{"key":"2025101723064388000_88.3.255.23","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1540-8159.1995.tb02470.x","volume":"18","year":"1995","journal-title":"PACE"},{"key":"2025101723064388000_88.3.255.24","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1161\/01.CIR.85.2.596","volume":"85","year":"1992","journal-title":"Circulation"},{"key":"2025101723064388000_88.3.255.25","unstructured":"Gullon SJ. 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