Relationships between cardiac innervation/perfusion imbalance and ventricular arrhythmias: impact on invasive electrophysiological parameters and ablation procedures View Full Text


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Article Info

DATE

2016-12

AUTHORS

Alessia Gimelli, Francesca Menichetti, Ezio Soldati, Riccardo Liga, Andrea Vannozzi, Paolo Marzullo, Maria Grazia Bongiorni

ABSTRACT

PURPOSE: To assess the relationship between regional myocardial perfusion and sympathetic innervation parameters at myocardial scintigraphy and intra-cavitary electrophysiological data in patients with ventricular arrhythmias (VA) submitted to invasive electrophysiological study and ablation procedure. METHODS: Sixteen subjects underwent invasive electrophysiological study with electroanatomical mapping (EAM) followed by trans-catheter ablations of VA. Before ablation all patients were studied with a combined evaluation of regional myocardial perfusion and sympathetic innervation by means of tomographic 99mTc-tetrofosmin and 123I- metaiodobenzylguanidine cadmium-zinc-telluride (CZT) scintigraphies, respectively. Off-line spatial co-registration of CZT perfusion and innervation data with the three-dimensional EAM reconstruction was performed in every patient. RESULTS: CZT revealed the presence of myocardial scar in 55 (20 %) segments. Of the viable myocardial segments, 131 (60 %) presented a preserved adrenergic innervation, while 86 (40 %) showed a significantly depressed innervation (i.e. innervation/perfusion mismatch). On EAM, the invasively measured intra-cavitary voltage was significantly lower in scarred segments than in viable ones (1.7 ± 1.5 mV vs. 4.0 ± 2.2 mV, P < 0.001). Interestingly, among the viable segments, those showing an innervation/perfusion mismatch presented a significantly lower intra-cavitary voltage than those with preserved innervation (1.9 ± 2.5 mV vs. 4.7 ± 2.3 mV, P < 0.001). Intra-cardiac ablation was performed in 63 (23 %) segments. On multivariate analysis, after correction for scar burden, the segments showing an innervation/perfusion mismatch remained the most frequent ablation targets (OR 5.6, 95 % CI 1.5-20.8; P = 0.009). CONCLUSIONS: In patients with VA, intra-cavitary electrical abnormalities frequently originate at the level of viable myocardial segments with depressed sympathetic innervation that frequently represents the ultimate ablation target. More... »

PAGES

2383-2391

References to SciGraph publications

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  • 2016-01. Electroanatomic mapping systems (CARTO/EnSite NavX) vs. conventional mapping for ablation procedures in a training program in CARDIAC ELECTROPHYSIOLOGY REVIEW
  • 2010-09. Use of Imaging Techniques to Guide Catheter Ablation Procedures in CURRENT CARDIOLOGY REPORTS
  • 2014-05. Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2016-02. The impact of acquisition time of planar cardiac 123I-MIBG imaging on the late heart to mediastinum ratio in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2014-10. I-123 mIBG and Tc-99m myocardial SPECT imaging to predict inducibility of ventricular arrhythmia on electrophysiology testing: A retrospective analysis in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2016-06. Quantitative iodine-123-metaiodobenzylguanidine (MIBG) SPECT imaging in heart failure with left ventricular systolic dysfunction: Development and validation of automated procedures in conjunction with technetium-99m tetrofosmin myocardial perfusion SPECT in JOURNAL OF NUCLEAR CARDIOLOGY
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    http://scigraph.springernature.com/pub.10.1007/s00259-016-3461-y

    DOI

    http://dx.doi.org/10.1007/s00259-016-3461-y

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1010153280

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/27430947


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        "description": "PURPOSE: To assess the relationship between regional myocardial perfusion and sympathetic innervation parameters at myocardial scintigraphy and intra-cavitary electrophysiological data in patients with ventricular arrhythmias (VA) submitted to invasive electrophysiological study and ablation procedure.\nMETHODS: Sixteen subjects underwent invasive electrophysiological study with electroanatomical mapping (EAM) followed by trans-catheter ablations of VA. Before ablation all patients were studied with a combined evaluation of regional myocardial perfusion and sympathetic innervation by means of tomographic 99mTc-tetrofosmin and 123I- metaiodobenzylguanidine cadmium-zinc-telluride (CZT) scintigraphies, respectively. Off-line spatial co-registration of CZT perfusion and innervation data with the three-dimensional EAM reconstruction was performed in every patient.\nRESULTS: CZT revealed the presence of myocardial scar in 55 (20\u00a0%) segments. Of the viable myocardial segments, 131 (60\u00a0%) presented a preserved adrenergic innervation, while 86 (40\u00a0%) showed a significantly depressed innervation (i.e. innervation/perfusion mismatch). On EAM, the invasively measured intra-cavitary voltage was significantly lower in scarred segments than in viable ones (1.7\u2009\u00b1\u20091.5\u00a0mV vs. 4.0\u2009\u00b1\u20092.2\u00a0mV, P\u2009<\u20090.001). Interestingly, among the viable segments, those showing an innervation/perfusion mismatch presented a significantly lower intra-cavitary voltage than those with preserved innervation (1.9\u2009\u00b1\u20092.5\u00a0mV vs. 4.7\u2009\u00b1\u20092.3\u00a0mV, P\u2009<\u20090.001). Intra-cardiac ablation was performed in 63 (23\u00a0%) segments. On multivariate analysis, after correction for scar burden, the segments showing an innervation/perfusion mismatch remained the most frequent ablation targets (OR 5.6, 95\u00a0% CI 1.5-20.8; P\u2009=\u20090.009).\nCONCLUSIONS: In patients with VA, intra-cavitary electrical abnormalities frequently originate at the level of viable myocardial segments with depressed sympathetic innervation that frequently represents the ultimate ablation target.", 
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