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Predicting the success of ventricular ablation: the role of sympathetic perfusion/innervation mismatch

Session Poster session III

Speaker Riccardo Liga

Event : ICNC, Nuclear Cardiology & Cardiac CT 2019

  • Topic : imaging
  • Sub-topic : Single Photon Emission Computed Tomography (SPECT)
  • Session type : Poster Session

Authors : R Liga (Pisa,IT), F Menichetti (Pisa,IT), E Soldati (Pisa,IT), N Scelza (Pisa,IT), G Zucchelli (Pisa,IT), A Di Cori (Pisa,IT), L Segreti (Pisa,IT), A Vannozzi (Pisa,IT), MG Bongiorni (Pisa,IT), P Marzullo (Pisa,IT), A Gimelli (Pisa,IT)

R Liga1 , F Menichetti2 , E Soldati1 , N Scelza1 , G Zucchelli1 , A Di Cori1 , L Segreti1 , A Vannozzi1 , MG Bongiorni1 , P Marzullo3 , A Gimelli1 , 1Azienda Ospedaliero-Universitaria Pisana - Pisa - Italy , 2Sant'Anna School of Advanced Studies - Pisa - Italy , 3Fondazione Toscana Gabriele Monasterio - Pisa - Italy ,

Single Photon Emission Computed Tomography (SPECT)

Background: Sympathetic dys-innervation is thought to play an important role in the development of ventricular arrhythmias (VA) in patients with ischemic heart disease (IHD). In this context, the presence and extent of myocardial perfusion/innervation mismatch (PIM) has been suggested as a novel predictor of arrhythmic events.

Purpose: Aim of this study was to prove that PIM evaluated by SPECT can identify areas of local abnormal ventricular activities (LAVA) on electro-anatomic mapping (EAM).

Methods: Sixteen patients with IHD referred to VA trans-catheter ablation underwent pre-procedural and 6 months post-ablation 123I-MIBG/99mTc-tetrofosmin rest SPECT myocardial imaging on a camera equipped with Cadmium-Zinc-Telluride detectors. PIM was defined according to the segmental distributions of 99mTc-tetrofosmin and 123I-MIBG. The EAM, performed with a dedicated system. During sinus rhythm, the LV and RV endocardium were mapped in order to obtain a bipolar voltage map with <20 mm point-to-point distance, at least in the segments of interest. Co-registration of scintigraphic and EAM LV reconstruction was achieved off-line by identifying the LV septum on the LV voltage maps and then defining the myocardial walls accordingly. A 17 segments LV analysis was used for either SPECT and LV EAM voltage map. All patients were followed-up clinically for at least 1 year.

Results: Ablation was clinically successful in 11/16 (69%) patients. At baseline, the mean summed rest score (SRS) and PIM score were 16±7 and 9±3, respectively. Before ablation, the mean voltage in the PIM segments (2.9±1.7 mV) was higher than in the scarred ones (1.4±0.9 mV; P<0.001 vs PIM) but lower than in the normal regions (4.4±2.3 mV; P<0.001 vs both PIM and scar). The presence of PIM in a specific LV zone was an independent predictor of LAVA (P<0.001). After ablation, PIM value was significantly reduced (6±4, P=0.027 vs baseline), mainly due to an increase in the SRS (21±8, P=0.054 vs baseline), in particular in patients that were responders to ablation (PIM 5±3, P=0.004 vs baseline; SRS 23±9, P=0.003 vs baseline).

Conclusions: PIM co-localizes with VA substrate expressed by LAVA, possibly providing a novel guide for trens-catether ablation. A significant reduction of PIM predicts a positive clinical response to ablation.

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