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Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Ablating left atrial (LA) ganglionated plexi (GP), identified invasively by high-frequency stimulation (HFS) during pulmonary vein isolation (PVI), may reduce atrial fibrillation (AF) recurrence. 123I-metaiodobenzylguanidine (123I-mIBG) solid-state SPECT LA innervation imaging (LAII) has the spatial resolution to detect LAGP non-invasively but this has never been demonstrated in clinical practice.

Methods

20 prospective patients with paroxysmal AF scheduled for PVI underwent 123I-mIBG LAII. High-resolution tomograms, reconstructed where possible using cardiorespiratory gating, were co-registered with pre-PVI cardiac CT. Location and reader confidence (1 [low] to 3 [high]) in discrete 123I-mIBG LA uptake areas (DUAs) were recorded and correlated with HFS.

Results

A total of 73 DUAs were identified, of which 59 (81%) were HFS positive (HFS +). HFS + likelihood increased with reader confidence (92% [score 3]). 64% of HFS-negative DUAs occurred over the lateral and inferior LA. Cardiorespiratory gating reduced the number of DUAs per patient (4 vs 7, P = .001) but improved: HFS + predictive value (76% vs 49%); reader confidence (2 vs 1, P = .02); and inter-observer, intra-observer, and inter-study agreement (κ = 0.84 vs 0.68; 0.82 vs 0.74; 0.64 vs 0.53 respectively).

Conclusions

123I-mIBG SPECT/CT LAII accurately and reproducibly identifies GPs verified by HFS, particularly when reconstructed with cardiorespiratory gating.

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Abbreviations

AF:

Atrial fibrillation

CZT:

Cadmium-zinc-telluride

DMR:

DUA-to-mediastinal ratio

DUA:

Discrete uptake area

GP:

Ganglionated plexus

HFS:

High-frequency stimulation

123I-mIBG:

Iodine-123 metaiodobenzylguanidine

SPECT:

Single-photon emission computed tomography

LAII:

Left atrial innervation imaging

PVI:

Pulmonary vein isolation

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Acknowledgements

The authors wish to thank U. Voss, Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, United Kingdom for contributing to data collection; and Samy Bross, Spectrum Dynamics Medical, Caesarea, Isarel, for contribution to the development of the phantom model.

Disclosure

JS, SE, DA, and SRU receive consultancy fees from Spectrum Dynamics Medical. JS receives speaker honoraria from Canon Medical Systems Europe (previously Toshiba Medical Systems Europe). UV was employed by a restricted research grant while NR, RB, and CB are employees of Spectrum Dynamics Medical.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the local Research Ethics Committee (London—Camberwell St Giles REC, reference 14/LO/2207) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards (Clinicatrials.gov Identifier NCT02267889).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Author notes

  1. S. Ernst and S. R. Underwood are joint senior authors.

Authors and Affiliations

  1. Department of Cardiology, Royal Berkshire Hospital NHS Foundation Trust, Craven Road, Reading, RG1 5AN, United Kingdom

    J. Stirrup MBBS, MD(Res), FRCP, FSCCT

  2. Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom

    S. Gregg MSc, CSci, MIPEM & S. R. Underwood DM, FRCP, FRCR, FESC, FASNC, FACC

  3. Spectrum Dynamics Medical, Caesarea, Israel

    R. Baavour, N. Roth & C. Breault BS, CNMT

  4. Department of Nuclear Medicine, CHU Caen and Normandy University EA 4650, Caen, France

    D. Agostini MD, PhD

  5. Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom

    S. Ernst MD, PhD, FESC

  6. Cardiovascular Research Center, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, United Kingdom

    S. Ernst MD, PhD, FESC

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  1. J. Stirrup MBBS, MD(Res), FRCP, FSCCT
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This study was supported by Spectrum Dynamics Medical.

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Stirrup, J., Gregg, S., Baavour, R. et al. Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation. J. Nucl. Cardiol. 27, 1939–1950 (2020). https://doi.org/10.1007/s12350-018-01535-5

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