Published Online
on July 30, 2008

A more recent version of this article appeared on September 1, 2008

This Article Full Text (PDF) Correction (v2,pe14) All Versions of this Article: 1/2/131    most recent CIRCIMAGING.108.782433v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bax, J. J. Articles by Jacobson, A. F. Search for Related Content PubMed PubMed Citation Articles by Bax, J. J. Articles by Jacobson, A. F. Related Collections Nuclear cardiology and PET Electrophysiology

Original Article

¹²³I-mIBG Scintigraphy to Predict Inducibility of Ventricular Arrhythmias on Cardiac Electrophysiology Testing: A Prospective Multicenter Pilot Study

Jeroen J. Bax¹; Otakar Kraft²; Alfred E. Buxton³; Jan Gunnar Fjeld⁴; Petr Parizek⁵; Denis Agostini⁶; Juhani Knuuti⁷; Albert Flotats⁸; James Arrighi³; Africa Muxi⁹; Marie-Jeanne Alibelli¹⁰; Gopa Banerjee¹¹ and Arnold F. Jacobson^11,12

¹ Leiden University Medical Centre, Leiden, The Netherlands;
² Department of Nuclear Medicine, University Hospital, Ostrava, Czech Republic;
³ The Warren Alpert Medical School, Brown University; Cardiology Division, Rhode Island Hospital, RI;
⁴ Rikshospitalet University Hospital, Oslo, Norway;
⁵ University Hospital, Hradec Kralove, Czech Republic;
⁶ CHU Cote de Nacre, Caen, France;
⁷ Turku University Central Hospital, Turku, Finland;
⁸ Autonomous University of Barcelona, Nuclear Medicine Department,Hospital de la Santa Creu, Spain;
⁹ Hospital Clinic i Provincial, Barcelona, Spain;
¹⁰ Centre Hospitalier Universitaire Rangueil, Toulouse Cedex, France;
¹¹ GE Healthcare, Princeton, NJ

¹² E-mail: arnold.jacobson{at}ge.com

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 relation 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 electrophysiologic (EP) testing and 15-minute and 4-hour planar and 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.<br>Thirty patients were EP+, 20 were EP-. There were no significant differences in the 4-hour H/M ratios or ¹²³I-mIBG/^99mTc-tetrofosmin SPECT mismatch scores for 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: arrhythmia • electrophysiology • nuclear medicine • scintigraphy • tachyarrhythmias

This article has been cited by other articles:

				L. F. Tops and J. J. Bax The Year in Imaging Related to Electrophysiology J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 498 - 510. [Full Text] [PDF]