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Original Articles

¹²³I-mIBG Scintigraphy to Predict Inducibility of Ventricular Arrhythmias on Cardiac Electrophysiology Testing

A Prospective Multicenter Pilot Study

Jeroen J. Bax, MD, PhD; Otakar Kraft, MD, PhD; Alfred E. Buxton, MD; Jan Gunnar Fjeld, MD; Petr Paízek, MD, PhD; Denis Agostini, MD, PhD; Juhani Knuuti, MD, PhD; Albert Flotats, MD, PhD; James Arrighi, MD; Africa Muxi, MD; Marie-Jeanne Alibelli, MD; Gopa Banerjee, MS and Arnold F. Jacobson, MD, PhD

From the Leiden University Medical Centre, Leiden, The Netherlands (J.J.B.); Department of Nuclear Medicine, University Hospital, Ostrava, Czech Republic (O.K.); The Warren Alpert Medical School of Brown University and Cardiology Division, Rhode Island Hospital, Providence, RI (A.F.B., J.A.); Rikshospitalet University Hospital, Oslo, Norway (J.G.F.); University Hospital, Hradec Kralove, Czech Republic (P.P.); CHU Cote de Nacre, Caen, France (D.A.); Turku University Central Hospital, Turku, Finland (J.K.); Autonomous University of Barcelona, Nuclear Medicine Department, Hospital de la Santa Creu, Barcelona, Spain (A.F.); Hospital Clinic i Provincial, Barcelona, Spain (A.M.); Centre Hospitalier Universitaire Rangueil, Toulouse Cedex, France (M.-J.A.); GE Healthcare, Princeton, NJ (G.B., A.F.J.).

Correspondence to Jeroen Bax, MD, PhD, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, The Netherlands. E-mail j.j.bax{at}lumc.nl

Received March 25, 2008; accepted July 21, 2008.

Background— Disturbances of autonomic function after infarction are associated with both total mortality and sudden death. Although many imaging techniques for assessing the cardiac autonomic nervous system have been studied, the clinical usefulness of these techniques remains uncertain. This exploratory pilot study examined the relationship between abnormalities of ventricular sympathetic innervation delineated by scintigraphic imaging with ¹²³I-mIBG and inducible ventricular tachyarrhythmias in patients with left ventricular dysfunction and previous myocardial infarction.

Methods and Results— Fifty patients underwent electrophysiological (EP) testing and 15-minute and 4-hour planar and single photon emission computed tomography (SPECT) imaging with ¹²³I-mIBG and SPECT imaging with ^99mTc-tetrofosmin. The primary efficacy variables were the 4-hour heart:mediastinum ratio (H/M) and the ¹²³I-mIBG/^99mTc-tetrofosmin SPECT mismatch score. EP studies were categorized as positive (EP⁺) or negative (EP^–) for inducibility of sustained (>30 seconds) ventricular tachyarrhythmias. Thirty patients were EP⁺, and 20 were EP^–. There were no significant differences in the 4-hour H/M ratios or ¹²³I-mIBG/^99mTc-tetrofosmin SPECT mismatch scores between the two groups. In a multivariable analysis using all ¹²³I-mIBG and ^99mTc-tetrofosmin SPECT measurements, the only variable that showed a significant difference between EP⁺ and EP^– patients was the 4-hour ¹²³I-mIBG SPECT defect score. A 4-hour ¹²³I-mIBG SPECT defect score of 37 yielded a sensitivity of 77% and specificity of 75% for predicting EP results.

Conclusions— The standard indices of ¹²³I-mIBG imaging (H/M and innervation-perfusion mismatch score) are not predictive of EP test results. The association of ¹²³I-mIBG SPECT defect severity with EP test inducibility in this exploratory study will require confirmation in a larger cohort of patients.

Key Words: electrophysiology • scintigraphy • tachyarrhythmias

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CLINICAL PERSPECTIVE

Ravin Davidoff, Senior Associate Editor, handled this manuscript.

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