Send to

Choose Destination
J Nucl Cardiol. 2019 Jan 29. doi: 10.1007/s12350-018-01535-5. [Epub ahead of print]

Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation.

Author information

Department of Cardiology, Royal Berkshire Hospital NHS Foundation Trust, Craven Road, Reading, RG1 5AN, United Kingdom.
Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Spectrum Dynamics Medical, Caesarea, Israel.
Department of Nuclear Medicine, CHU Caen and Normandy University EA 4650, Caen, France.
Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Cardiovascular Research Center, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom.



Ablating left atrial (LA) ganglionated plexi (GP), identified invasively by high-frequency stimulation (HFS) during pulmonary vein isolation (PVI), may reduce atrial fibrillation (AF) recurrence. 123I-metaiodobenzylguanidine (123I-mIBG) solid-state SPECT LA innervation imaging (LAII) has the spatial resolution to detect LAGP non-invasively but this has never been demonstrated in clinical practice.


20 prospective patients with paroxysmal AF scheduled for PVI underwent 123I-mIBG LAII. High-resolution tomograms, reconstructed where possible using cardiorespiratory gating, were co-registered with pre-PVI cardiac CT. Location and reader confidence (1 [low] to 3 [high]) in discrete 123I-mIBG LA uptake areas (DUAs) were recorded and correlated with HFS.


A total of 73 DUAs were identified, of which 59 (81%) were HFS positive (HFS +). HFS + likelihood increased with reader confidence (92% [score 3]). 64% of HFS-negative DUAs occurred over the lateral and inferior LA. Cardiorespiratory gating reduced the number of DUAs per patient (4 vs 7, P = .001) but improved: HFS + predictive value (76% vs 49%); reader confidence (2 vs 1, P = .02); and inter-observer, intra-observer, and inter-study agreement (κ = 0.84 vs 0.68; 0.82 vs 0.74; 0.64 vs 0.53 respectively).


123I-mIBG SPECT/CT LAII accurately and reproducibly identifies GPs verified by HFS, particularly when reconstructed with cardiorespiratory gating.


Nuclear medicine; atrial fibrillation; catheter ablation; ganglionated plexi; imaging; mIBG, SPECT/CT, CZT; mapping; nervous system, autonomic

Free full text

Supplemental Content

Full text links

Icon for Springer Icon for Spiral, Imperial College Digital Repository
Loading ...
Support Center