Romanov A B, Shabanov V V, Losik D V, Elesin D A, Stenin I G, Minin S M, Nikitin N A, Mikheenko I L, Pokushalov E A
National Medical Research Center named after acad. E. N. Meshalkin, Novosibirsk.
Kardiologiia. 2019 Apr 16;59(4):33-38. doi: 10.18087/cardio.2019.4.10249.
A novel cardiac gamma camera utilizes the radiopharmaceutical Iodine-123-Meta-iodobenzylguanidine (123I-MIBG) to visualize cardiac sympathetic innervation. Physiological accumulation of 123I-mIBG provides an anatomical quantitative determination of the structures of the autonomic nervous system (ANS) with discrete uptake areas (DUA) of sympathetic activity located in the left atrium (LA) corresponding to the main ganglionic plexi (GP) clusters that could not previously be visualized.
to visualize the DUA of the heart in patients with paroxysmal atrial fibrillation (AF) and to assess the effect of radiofrequency ablation (RFA) on DUA in LA.
Computed tomography (CT) of the heart and radionuclide imaging with 123I-mIBG were performed in 15 patients with paroxysmal AF. The results of the study were combined with preliminary taken CT images to create a detailed anatomical map of the sympathetic activity of the heart. The processed images were combined with the 3D reconstruction of the LA, obtained with the navigation system (CARTO 3, CARTO RMT). In DUA, high-frequency stimulation (HFS) followed by RF ablation was performed using the current recommended parameters.
Forty-eight DUA (median 3 [3; 3]) were identified. Average activity of DUA was 1315 [1171; 1462] cnt / sec / ml. Positive response to HFS in the DUA was obtained in 8 (53.3 %) patients. Prior to ablation, no response was received to HFS in areas of LA outside the DUA. After ablation, there was no response to HFS in the DUA sites. At repeated scans 3 DUA (median 0 [0; 0]; p<0.001 compared with preoperative data) were observed. Activity of DUA significantly decreased to 819 [684; 955] cnt / sec / ml (p<0.001 as compared with preoperative data). Thirteen of 13 of 15 patients (87 %) had no AF / AT / AFL recurrences for 6 month follow up.
In patients with AF, the areas of sympathetic activity in LA can be visualized by physiological localized uptake of 123I-mIBG. Radiofrequency catheter ablation can target the identified sympathetic innervation structures in AF patients precisely and effectively.
一种新型心脏伽马相机利用放射性药物碘 - 123 - 间碘苄胍（123I - MIBG）来可视化心脏交感神经支配。123I - mIBG的生理性聚集提供了自主神经系统（ANS）结构的解剖学定量测定，其交感神经活动的离散摄取区域（DUA）位于左心房（LA），对应于先前无法可视化的主要神经节丛（GP）簇。
可视化阵发性心房颤动（AF）患者心脏的DUA，并评估射频消融（RFA）对左心房DUA的影响。
对15例阵发性AF患者进行心脏计算机断层扫描（CT）和123I - mIBG核素成像。将研究结果与预先采集的CT图像相结合，以创建心脏交感神经活动的详细解剖图。处理后的图像与通过导航系统（CARTO 3，CARTO RMT）获得的左心房三维重建图像相结合。在DUA中，使用当前推荐参数进行高频刺激（HFS），随后进行射频消融。
共识别出48个DUA（中位数3 [3; 3]）。DUA的平均活性为1315 [1171; 1462] 计数/秒/毫升。8例（53.3%）患者的DUA对HFS有阳性反应。消融前，左心房DUA以外区域对HFS无反应。消融后，DUA部位对HFS无反应。在重复扫描时，观察到3个DUA（中位数0 [0; 0]；与术前数据相比，p<0.001）。DUA的活性显著降低至819 [684; 955] 计数/秒/毫升（与术前数据相比，p<0.001）。15例患者中的13例（87%）在6个月的随访中无房颤/房性心动过速/房扑复发。
在房颤患者中，可通过123I - mIBG的生理性局部摄取来可视化左心房的交感神经活动区域。射频导管消融可精确有效地靶向房颤患者中已识别的交感神经支配结构。
