Our Summary

This research study looked into whether a certain type of imaging done before a procedure called catheter ablation could predict if patients with persistent atrial fibrillation (AF) would experience a relapse. Atrial fibrillation is a heart condition that causes irregular and often very fast heart rate.

The imaging technique used is called 123I-mIBG cardiac imaging. It was carried out on 82 patients before their catheter ablation procedure. The patients were then followed up for a year.

The findings showed that certain measurements from the imaging (H/Mlate and WR) could independently predict the chance of the AF coming back after the procedure. The analysis showed that if H/Mlate was less than 1.6 and WR was more than 25.11, there was a high chance of AF recurrence within a year after the procedure.

In simple terms, the study suggests that this imaging technique could help doctors predict whether the irregular heartbeats might return in patients with persistent AF who have undergone this specific procedure. This could be particularly helpful for patients with normal heart function (LVEF) and no significant coronary artery disease (CAD).

FAQs

  1. What is the purpose of pre-CA 123-I-mIBG imaging in relation to atrial fibrillation (AF)?
  2. What were the findings in the study regarding the predictive power of H/Mlate and WR in relation to AF recurrence?
  3. How are pre-CA parameters of global cardiac sympathetic activity associated with late AF relapses?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cardiac ablation is to consider undergoing pre-CA 123I-mIBG imaging to assess cardiac sympathetic activity. This imaging can help predict the likelihood of late atrial fibrillation recurrence after the procedure. Patients with persistent AF and normal LVEF may benefit from this additional evaluation to better understand their individual risk factors for AF relapses.

Suitable For

Patients with persistent atrial fibrillation (AF) who are undergoing catheter ablation (CA) may be recommended cardiac ablation if they have normal left ventricular ejection fraction (LVEF) and do not have significant coronary artery disease (CAD). Additionally, patients who have pre-CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy, such as a late heart-to-mediastinum ratio (H/Mlate) of less than 1.6 and a washout rate (WR) of greater than 25.11, may be at higher risk for late AF recurrence and may benefit from cardiac ablation.

Timeline

Before cardiac ablation:

  • Patient undergoes pre-CA 123I-mIBG cardiac imaging
  • Parameters such as late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) are measured
  • Patient is followed for 12 months post-CA

After cardiac ablation:

  • Multivariable analysis shows H/Mlate and WR are independent predictors of AF recurrence
  • ROC-curve analysis indicates H/Mlate<1.6 and WR > 25.11 are associated with high probability of AF relapses
  • Conclusion: Pre-CA parameters of global cardiac sympathetic activity are associated with late AF relapses in persistent AF patients with normal LVEF and absence of significant CAD.

What to Ask Your Doctor

  1. How does cardiac ablation work to treat atrial fibrillation?
  2. What are the potential risks and complications associated with cardiac ablation?
  3. How successful is cardiac ablation in treating persistent atrial fibrillation?
  4. How can pre-CA parameters of global cardiac sympathetic activity measured by 123I-mIBG scintigraphy help predict late AF recurrence?
  5. What is the significance of a heart-to-mediastinum ratio (H/M) of less than 1.6 and a washout rate (WR) greater than 25.11 in predicting AF relapses after CA?
  6. Are there any other imaging tests or prognostic indicators that can help predict outcomes after cardiac ablation for atrial fibrillation?
  7. What is the follow-up care and monitoring recommended after cardiac ablation for persistent AF?
  8. How soon after the procedure can I expect to see improvements in my symptoms of atrial fibrillation?
  9. Are there any lifestyle changes or medications that can help reduce the risk of AF recurrence after cardiac ablation?
  10. What is the success rate of cardiac ablation in preventing AF recurrence in patients with persistent AF and normal left ventricular ejection fraction (LVEF)?

Reference

Authors: Sazonova SI, Varlamova JV, Nikitin NA, Minin SM, Kisteneva IV, Batalov RE, Mishkina AI, Ilushenkova YN, Zavadovsky KV, Popov SV, Romanov AB. Journal: J Nucl Cardiol. 2022 Oct;29(5):2220-2231. doi: 10.1007/s12350-021-02658-y. Epub 2021 May 27. PMID: 34046802