Cardiac sympathetic transmitter stores are reduced in the failing heart. In this study, we proposed to investigate whether the reduction of cardiac sympathetic neurotransmitters was associated with increased interstitial norepinephrine (NE) and reactive oxygen species in congestive heart failure (CHF), using a microdialysis technique and salicylate to detect ⅐OH generation. Rabbits with and without rapid ventricular pacing (340 beats/min) were randomized to receive desipramine (10 mg/day) or placebo for 8 wk. Rapid pacing produced left ventricular dilation and systolic dysfunction. The failing myocardium also showed reduced tissue contents of NE and tyrosine hydroxylase protein and activity. In contrast, myocardial interstitial NE was increased in CHF (0.89 Ϯ 0.11 ng/ml) compared with the sham-operated animals (0.26 Ϯ 0.03 ng/ml). In addition, cardiac oxidative stress was increased in CHF animals as measured by myocardial interstitial ⅐OH radical, tissue oxidized glutathione, and oxidized mitochondrial DNA. Desipramine treatment produced significant NE uptake inhibition as evidence by an exaggerated pressor response and a greater increase of myocardial interstitial NE in response to intravenous NE infusion but no significant effects on cardiac function or hemodynamics in sham-operated or CHF animals. However, desipramine treatment attenuated the reductions of tissue NE and tyrosine hydroxylase protein and activity in CHF. Desipramine also prevented the reduction of tyrosine hydroxylase produced by NE in PC12 cells. Thus the reduction of cardiac sympathetic neurotransmitters is related to the increased interstitial NE and tissue oxidative stress in CHF. Also, normal neuronal uptake of NE is required for NE or its oxidized metabolites to exert their neurotoxic effects. oxidative stress; microdialysis; tyrosine hydroxylase; norepinephrine; ceramide.DEPLETION OF CARDIAC NOREPINEPHRINE (NE) is one of the important salient features in human congestive heart failure (CHF) (7, 9). Prior studies (5,7,9,16,17) have shown that cardiac NE is depleted in CHF because of increased preferential cardiac release of NE, reduced neuronal reuptake of NE, and impaired NE synthesis. Tyrosine hydroxylase, a rate-limiting enzyme in NE biosynthesis (37), is reduced in heart failure (16, 53), which may account, at least in part, for the reduced production of NE. Recently, we observed in several animal models of experimental CHF (23,30,39,41) that the sympathetic nerve profiles as measured by NE histofluorescence and tyrosine hydroxylase immunocytochemistry are reduced in CHF, but there is no significant reduction of protein gene product 9.5 (PGP9.5) (41), a panneuronal marker (20,29,57). Thus the anatomic integrity of the cardiac sympathetic nerves probably is intact in CHF, and the changes of sympathetic neurotransmitters within the nerve endings are caused by functional abnormalities that are potentially reversible with either effective therapy or removal of primary insult that causes heart failure as discontinuation of cardiac pacing i...