Pulmonary vein isolation in patients with paroxysmal atrial fibrillation is associated with regional cardiac sympathetic denervation

EJNMMI Research
Christian WenningMichael Schäfers

Abstract

Circumferential pulmonary vein isolation (PVI) is the cornerstone of the current state-of-the-art management of atrial fibrillation (AF). However, the precise mechanisms behind AF relapses post PVI are still unknown. Since the activity of the autonomous nervous system is crucial in triggering paroxysmal AF, we hypothesized that PVI is associated with changes of cardiac sympathetic activity. Sixteen patients with paroxysmal AF underwent cardiac iodine-123-meta-iodobenzylguanidine (123I-mIBG) planar cardiac imaging and single-photon emission computed tomography with low-dose computed tomography (SPECT/CT) for attenuation correction before and 4 weeks after PVI. The heart-to-mediastinum ratio (H/M ratio), washout rate (WR), regional myocardial uptake, and regional washout were analyzed. The late H/M ratio was unchanged by PVI (pre, 2.9 ± 0.5 vs. post, 2.7 ± 0.6, p = 0.53). Four of the 16 patients (25%) displayed regional deficits before PVI. After PVI, regional deficits were present in ten patients (62.5%) with newly emerging deficits localized in the inferolateral wall. In a 6-month follow-up, four out of the ten patients (40%) with regional 123I-mIBG defects suffered from a recurrence of AF, while only one of the six patients (1...Continue Reading

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Citations

Jul 18, 2015·International Journal of Cardiology·Masaharu MasudaYasushi Sakata
Jan 30, 2019·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Anna Teresińska
Feb 24, 2017·The International Journal of Cardiovascular Imaging·Philipp S LangeChristian Wenning
May 29, 2021·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·S I SazonovaA B Romanov
May 18, 2021·Frontiers in Cardiovascular Medicine·Alessia GimelliRiccardo Liga
Jun 26, 2021·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Claudio Marcassa

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Methods Mentioned

BETA
sedation

Software Mentioned

Ensite Verismo
SyngoVolumetry
Corridor 4D - MSPECT
Ensite NavX Velocity
SPSS

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