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

Authors
  • Stirrup, J1
  • Gregg, S2
  • Baavour, R3
  • Roth, N3
  • Breault, C3
  • Agostini, D4
  • Ernst, S5, 6
  • Underwood, S R2
  • 1 Department of Cardiology, Royal Berkshire Hospital NHS Foundation Trust, Craven Road, Reading, RG1 5AN, United Kingdom. [email protected] , (United Kingdom)
  • 2 Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. , (United Kingdom)
  • 3 Spectrum Dynamics Medical, Caesarea, Israel. , (Israel)
  • 4 Department of Nuclear Medicine, CHU Caen and Normandy University EA 4650, Caen, France. , (France)
  • 5 Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. , (United Kingdom)
  • 6 Cardiovascular Research Center, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom. , (United Kingdom)
Type
Published Article
Journal
Journal of Nuclear Cardiology
Publisher
Springer-Verlag
Publication Date
Dec 01, 2020
Volume
27
Issue
6
Pages
1939–1950
Identifiers
DOI: 10.1007/s12350-018-01535-5
PMID: 30694425
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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.

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