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Predictors of ventricular ablation’s success: Viability, innervation, or mismatch?

  • Alessia GimelliEmail author
  • Francesca Menichetti
  • Ezio Soldati
  • Riccardo Liga
  • Nicola Scelza
  • Giulio Zucchelli
  • Andrea Di Cori
  • Luca Segreti
  • Andrea Vannozzi
  • Maria Grazia Bongiorni
  • Paolo Marzullo
Original Article
  • 8 Downloads

Abstract

Aims

Sympathetic dys-innervation may play an important role in the development of post-ischemic ventricular arrhythmias (VA). Aim of this study was to prove that perfusion/innervation mismatch (PIM) evaluated by SPECT can identify areas of local abnormal ventricular activities (LAVA) on electroanatomic mapping (EAM).

Methods

Sixteen patients referred to post-ischemic VA catheter ablation underwent pre-procedural and 1-month post-ablation 123I-MIBG/99mTc-tetrofosmin rest SPECT myocardial imaging. PIM was defined according to the segmental distributions of 99mTc-tetrofosmin and 123I-MIBG. A 17-segment LV analysis was used for either SPECT or LV EAM voltage map. All patients were followed up clinically for at least 1 year.

Results

Before ablation, the mean voltage in the PIM segments was higher than in the scarred ones but lower than in the normal regions. The presence of PIM in a specific LV zone was an independent predictor of LAVA. After ablation, PIM value was significantly reduced, mainly due to an increase in perfusion summed rest score, in particular in patients that were responders to ablation.

Conclusions

PIM may associate with VA substrate expressed by LAVA and might provide a novel guide for substrate ablation. A significant reduction of PIM could predict a positive clinical response to ablation.

Keywords

Intervention tracers image-guided application diagnostic and prognostic application cardiac innervation multimodality 

Abbreviations

IHD

Ischemic heart disease

VA

Ventricular arrhythmias

ICD

Implantable cardioverter-defibrillator

EAM

Electro-anatomical mapping

VT

Ventricular tachycardia

LAVA

Local abnormal ventricular activities

SNS

Sympathetic nervous system

123I-MIBG

123I-metaiodobenzylguanigine

PIM

Perfusion/innervations mismatch

Notes

Disclosures

The authors have nothing to disclose.

Supplementary material

12350_2018_1575_MOESM1_ESM.doc (32 kb)
Supplementary material 1 (DOC 32 kb)
12350_2018_1575_MOESM2_ESM.doc (32 kb)
Supplementary material 2 (DOC 32 kb)
12350_2018_1575_MOESM3_ESM.ppt (948 kb)
Supplementary material 3 (PPT 947 kb)
12350_2018_1575_MOESM4_ESM.doc (24 kb)
Supplementary material 4 (DOC 23 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Alessia Gimelli
    • 1
    Email author
  • Francesca Menichetti
    • 2
    • 3
  • Ezio Soldati
    • 2
  • Riccardo Liga
    • 2
  • Nicola Scelza
    • 2
  • Giulio Zucchelli
    • 2
  • Andrea Di Cori
    • 2
  • Luca Segreti
    • 2
  • Andrea Vannozzi
    • 2
  • Maria Grazia Bongiorni
    • 2
  • Paolo Marzullo
    • 1
    • 4
  1. 1.Fondazione Toscana G. MonasterioPisaItaly
  2. 2.Cardio-Thoracic and Vascular DepartmentUniversity Hospital of PisaPisaItaly
  3. 3.Sant’Anna, School of Advanced StudiesPisaItaly
  4. 4.CNR, Institute of Clinical PhysiologyPisaItaly

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