‘ICD in Primary Prevention: Potential Role of Sympathetic Nerve Imaging’

Patients with chronic heart failure (CHF) and left ventricular ejection fraction (LVEF) 35% are at increased risk for sudden cardiac death (SCD). These patients are likely to receive an implantable cardioverter defibrillator (ICD), effective in reducing the occurrence of SCD in primary prevention. The decision to use an ICD in CHF, according to the current guidelines, is based on New York Heart Association classification (NYHA) of II or III and a LVEF 35%, but reduced LVEF is a nonspecific predictor of potentially fatal arrhythmic events. Many studies have shown that a (123)Imetaiodobenzylguanidine ((123)I-MIBG) scintigraphy, which identifies sympathetic nervous system dysfunction, is useful for determining the prognosis in CHF patients. This case report describes the potential role of (123)I-MIBG into the decision-making process for ICD placement, improving the accuracy in the selection of patients most likely to benefit from an ICD implantation.