Cardiac ¹²³I-mIBG scintigraphy for prediction of catheter ablation outcome in patients with atrial fibrillation

Background: Previous studies show inconsistent results on the role of innervation imaging (with ¹²³I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post-CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF.

Methods: ¹²³I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patient was followed for 12 months.

Results: Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/M_late) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/M_late <1.6 (sensitivity 73.53%, specificity 81.3%, AUC 0.792, P < .001) and WR > 25.11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0.712, P < .001) indicate high probability of AF relapses during 12 months after CA.

Conclusion: Pre-CA parameters of global cardiac sympathetic activity estimated by ¹²³I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients with normal LVEF and absence of significant CAD.