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

Abstract

BackgroundCircumferential 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.MethodsSixteen 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.ResultsThe 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 (16.7%) without a regional 123I-mIBG defect experienced a recurrence.ConclusionA significant number of patients with paroxysmal AF show regional cardiac sympathetic innervation deficits at baseline. In addition, PVI is associated with newly emerging defects. The presence of regional sympathetic denervation after PVI may correlate with the risk of AF relapses.

Digital Technologies in Providing Development of Algorithms Surgical Treatment of Supraventricular Arrhythmias

“…Thus, to determine the indications for the procedure of "MAZE III" expedient to EPS on technology developed before the intervention with the assessment of the functional state of the sinoatrial node. When it is appropriate we need to assess the initial severity of the patient's condition and the effect on it of atrial fibrillation [21][22][23][24][25]. If AF has no pronounced negative effect on the hemodynamics of the patient, it makes sense to restrict the atrial appendages off by their resection and suturing, in addition to the main stage of the operation to reduce the risk of thromboembolic complications.…”

Impact of atrial fibrillation ablation on cardiac sympathetic nervous system in patients with and without heart failure

“…Arimoto et al performed 123 I-mIBG on the day prior to and 5 days post-ablation in 20 AF patients [1], while Wenning et al performed regional analysis and reported a newly emerging deficit in 123 I-mIBG uptake in left ventricle 1 month post-ablation [9]. In these studies, H/M during the early and delayed phases and WR did not markedly change post-ablation.…”

I-123-MIBG cardiac innervation imaging in patients with atrial fibrillation

“…[1][2][3] The adrenergic part of CANS can be evaluated with I-123-metaiodobenzylguanidine (MIBG), which is a norepinephrine analog and a tracer for sympathetic neuron integrity and function. 4 MIBG imaging has been performed to assess patients with AF, for: (1) the prognosis of patients with paroxysmal atrial fibrillation (PAF) 5,6 ; (2) the prediction of outcome of catheter ablation of AF 7,8 ; and (3) evaluation of denervation/ renervation after AF ablation. 8,9 In patients with PAF and without structural heart disease, CAS abnormality defined as reduced H/M ratio from planar MIBG delayed imaging was a predictor of vascular events (myocardial infarction, stroke, or heart failure) during a mean of 4.5 years follow-up.…”