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Open Access 01-12-2013 | Original research

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

Authors: Christian Wenning, Philipp S Lange, Christoph Schülke, Alexis Vrachimis, Gerold Mönnig, Otmar Schober, Lars Eckardt, Michael Schäfers

Published in: EJNMMI Research | Issue 1/2013

Abstract

Background

Circumferential 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.

Methods

Sixteen 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.

Results

The 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.

Conclusion

A 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.

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Title: Pulmonary vein isolation in patients with paroxysmal atrial fibrillation is associated with regional cardiac sympathetic denervation
Authors: Christian Wenning
Philipp S Lange
Christoph Schülke
Alexis Vrachimis
Gerold Mönnig
Otmar Schober
Lars Eckardt
Michael Schäfers
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: EJNMMI Research / Issue 1/2013
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/2191-219X-3-81

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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