Three-Dimensional 123I-Meta-Iodobenzylguanidine Cardiac Innervation Maps to Assess Substrate and Successful Ablation Sites for Ventricular Tachycardia: Feasibility Study for a Novel Paradigm of Innervation Imaging

Thomas Klein, Mohammed Abdulghani, Mark Smith, Rui Huang, Ramazan Asoglu, Benjamin F. Remo, Aharon Turgeman, Olurotimi Mesubi, Sunjeet Sidhu, Stephen Synowski, Anastasios Saliaris, Vincent See, Stephen Shorofsky, Wengen Chen, Vasken Dilsizian, Timm Dickfeld

Research output: Contribution to journalArticle

Abstract

Background - Innervation is a critical component of arrhythmogenesis and may present an important trigger/substrate modifier not used in current ventricular tachycardia (VT) ablation strategies. Methods and Results - Fifteen patients referred for ischemic VT ablation underwent preprocedural cardiac 123I- meta-iodobenzylguanidine (123I-mIBG) imaging, which was used to create 3-dimensional (3D) innervation models and registered to high-density voltage maps. 3D 123I-mIBG innervation maps demonstrated areas of complete denervation and 123I-mIBG transition zone in all patients, which corresponded to 0% to 31% and 32% to 52% uptake. 123I-mIBG denervated areas were ≈2.5-fold larger than bipolar voltage-defined scar (median, 24.6% [Q1-Q3, 18.3%-34.4%] versus 10.6% [Q1-Q3, 3.9%-16.4%]; P<0.001) and included the inferior wall in all patients, with no difference in the transition/border zone (11.4% [Q1-Q3, 9.5%-13.2%] versus 16.6% [Q1-Q3, 12.0%-18.8%]; P=0.07). Bipolar/unipolar voltages varied widely within areas of denervation (0.8 mV [Q1-Q3, 0.3-1.7 mV] and 4.0 mV [Q1-Q3, 2.9-5.6 mV]) and 123I-mIBG transition zones (0.8 mV [Q1-Q3, 0.4-1.8 mV] and 4.6 mV [Q1-Q3, 3.2-6.3 mV]). Bipolar voltages in denervated areas and 123I-mIBG transition zones were <0.5 mV, 0.5 to 1.5 mV, and >1.5 mV in 35%, 36%, and 29%, as well as 35%, 35%, and 30%, respectively (P>0.05). Successful ablation sites were within bipolar voltage-defined scar (7%), border zone (57%), and areas of normal voltage (36%), but all ablation sites were abnormally innervated (denervation/123I-mIBG transition zone in 50% each). Conclusions - 123I-mIBG innervation defects are larger than bipolar voltage-defined scar and cannot be detected with standard voltage criteria. Thirty-six percent of successful VT ablation sites demonstrated normal voltages (>1.5 mV), but all ablation sites were within the areas of abnormal innervation. 123I-mIBG innervation maps may provide critical information about triggers/substrate modifiers and could improve understanding of VT substrate and facilitate VT ablation. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01250912.

Original languageEnglish (US)
Pages (from-to)583-591
Number of pages9
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number3
DOIs
StatePublished - Jun 4 2015
Externally publishedYes

Keywords

  • cardiac imaging techniques
  • innervation
  • tachycardia, ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Klein, T., Abdulghani, M., Smith, M., Huang, R., Asoglu, R., Remo, B. F., Turgeman, A., Mesubi, O., Sidhu, S., Synowski, S., Saliaris, A., See, V., Shorofsky, S., Chen, W., Dilsizian, V., & Dickfeld, T. (2015). Three-Dimensional 123I-Meta-Iodobenzylguanidine Cardiac Innervation Maps to Assess Substrate and Successful Ablation Sites for Ventricular Tachycardia: Feasibility Study for a Novel Paradigm of Innervation Imaging. Circulation: Arrhythmia and Electrophysiology, 8(3), 583-591. https://doi.org/10.1161/CIRCEP.114.002105