Cardiac 123I-mIBG scintigraphy for prediction of catheter ablation outcome in patients with atrial fibrillation

<div><strong>Aim.</strong> To evaluate global and regional sympathetic activity in patients with atrial fibrillation using <sup>123</sup>I-metaiodbenzylguanidine (<sup>123</sup>I-MIBG) scintigraphy before and after catheter ablation.</div><div><strong>Methods.</strong> A total of 45 patients with paroxysmal and persistent atrial fibrillation (mean age, 55 ± 10 years; 44% women) followed up till catheter ablation were included in the study. All study participants underwent <sup>123</sup>I-MIBG scintigraphy within 1–2 days before and 5–7 days after catheter ablation. The global myocardial sympathetic activity was estimated by calculating the ratio of <sup>123</sup>I-MIBG uptake in the heart and mediastinum in the early and delayed phases (H/Me and H/Md), as well as the <sup>123</sup>I-MIBG wash out rate in 4 h (WR). Regional sympathetic activity was estimated by semiquantitative analysis of the 123I-MIBG uptake in the myocardium of the left ventricle.</div><div><strong>Results.</strong> Baseline <sup>123</sup>I-MIBG scintigraphy showed the difference between paroxysmal and persistent atrial fibrillation patients in WR only (19.2 ± 6.4 and 23.9 ± 7.2, respectively; p = 0.03). A statistically significant decrease of H/Md in average of 0.1 (95% confidence interval, 0.02–0.2; p = 0.02) was found in patients with paroxysmal atrial fibrillation, and a decrease of WR in average of 3.7% (95% confidence interval, −7% to −0.4%; p = 0.03) after catheter ablation. No statistically significant changes of H/Md and WR were found in patients with persistent atrial fibrillation after catheter ablation. The analysis of regional 123I-MIBG uptake in the left ventricular myocardium did not show any statistically significant changes in the regional sympathetic activity after catheter ablation compared with that at baseline.</div><div><strong>Conclusion.</strong> The differences in WR only were found between patients with paroxysmal and persistent atrial fibrillation. Significant changes in myocardial sympathetic activity after catheter ablation were found only in patients with paroxysmal atrial fibrillation, a finding that may be associated with a large number of active sympathetic nerve endings in the myocardium compared with patients with persistent atrial fibrillation.</div><div>ClinicalTrials.gov Identifier: NCT02914860</div><div>Received 23 April 2019. Accepted 26 May 2019.</div><div><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</div><div><strong>Funding:</strong> The study is a part of a research project supported of a grant of the Russian Science Foundation No. 17-75-20118.</div>

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Value of cardiac 123I-mIBG scintigraphy in prognosis of catheter ablation outcome in patients with atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.081 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

S Sazonova ◽

JV Varlamova ◽

NA Nikitin ◽

SM Minin ◽

IV Kisteneva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Multivariable Analysis ◽

Analysis Data ◽

Washout Rate ◽

Mibg Scintigraphy ◽

Roc Curve Analysis ◽

Russian Science ◽

Patients At Risk ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation Background. Previous studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. Thus, the goal of the present study was to estimate the utility of pre-procedural cardiac 123I-mIBG scintigraphy to identify patients at risk for AF recurrence after CA. Methods. 123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patients were followed for 12 months. A blanking period of 3 months was applied. The primary endpoint of the study was AF recurrence between 3 and 12 months after ablation. Results. Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate <1.6 (sensitivity 73.53 %, specificity 81.3%, AUC 0,792 , p < 0.001) and WR > 25,11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0,712 , p < 0.001) indicate high probability of AF relapses during 12 months after CA. Kaplan-Meier analysis showed that the H/Mlate < 1.6, WR > 25,11 and LAD > 45 mm significantly increase the risk of AF recurrence after CA (p < 0.001, p < 0.001, p < 0.025 respectively). Conclusion. Pre CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients.

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