Alessia Gimelli1, Francesca Menichetti2, Ezio Soldati2, Riccardo Liga2, Andrea Vannozzi2, Paolo Marzullo3,4, Maria Grazia Bongiorni2. 1. Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy. gimelli@ftgm.it. 2. Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy. 3. Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy. 4. CNR, Institute of Clinical Physiology, Pisa, Italy.
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.
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.
Authors: C Zhao; N Shuke; W Yamamoto; A Okizaki; J Sato; Y Ishikawa; T Ohta; N Hasebe; K Kikuchi; T Aburano Journal: J Nucl Med Date: 2001-07 Impact factor: 10.057
Authors: Yanli Zhou; Weihua Zhou; Russell D Folks; Daya N Manatunga; Arnold F Jacobson; Jeroen J Bax; Ernest V Garcia; Ji Chen Journal: J Nucl Cardiol Date: 2014-05-24 Impact factor: 5.952
Authors: Matthias Paul; Thomas Wichter; Peter Kies; Joachim Gerss; Christian Wollmann; Kambiz Rahbar; Lars Eckardt; Günter Breithardt; Otmar Schober; Eric Schulze-Bahr; Michael Schäfers Journal: J Nucl Med Date: 2011-09-09 Impact factor: 10.057
Authors: Jeroen J Bax; Otakar Kraft; Alfred E Buxton; Jan Gunnar Fjeld; Petr Parízek; Denis Agostini; Juhani Knuuti; Albert Flotats; James Arrighi; Africa Muxi; Marie-Jeanne Alibelli; Gopa Banerjee; Arnold F Jacobson Journal: Circ Cardiovasc Imaging Date: 2008-07-30 Impact factor: 7.792