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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

1
Department of Cardiology, Royal Berkshire Hospital NHS Foundation Trust, Craven Road, Reading, RG1 5AN, United Kingdom. james.stirrup@royalberkshire.nhs.uk.
2
Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
3
Spectrum Dynamics Medical, Caesarea, Israel.
4
Department of Nuclear Medicine, CHU Caen and Normandy University EA 4650, Caen, France.
5
Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
6
Cardiovascular Research Center, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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

KEYWORDS:

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

PMID:
30694425
DOI:
10.1007/s12350-018-01535-5
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