title: Iodine-123 mIBG Imaging for Predicting the Development of Atrial Fibrillation.
abstract: OBJECTIVE
  we investigated whether cardiac sympathetic nervous system (SNS) activity measured by iodine-123 meta-iodobenzylguanidine ((123)I-mIBG) imaging would be associated with both the occurrence of heart failure (HF) and the transit to permanent atrial fibrillation (AF) in patients with paroxysmal AF.
  
  
  BACKGROUND
  atrial fibrillation occurs suddenly and transiently and can persist, and results in the occurrence of HF. An important feature of AF and HF is their propensity to coexist not only because they share antecedent risk factors, but also because the one may directly predispose the heart to the other. However, a useful modality for predicting the occurrences of both those has not been established in patients with paroxysmal AF.
  
  
  METHODS
  the (123)I-mIBG scintigraphy was performed to evaluate cardiac SNS activity presented as the heart/mediastinum ratio in 98 consecutive patients (age 66 ± 13 years, 63.3% male) with idiopathic paroxysmal AF and preserved left ventricular ejection fraction (≥ 50%).
  
  
  RESULTS
  during 4 ± 3.6 years of follow-up, the transit to permanent AF was associated with the occurrence of HF (34.3% in 12 of 35 patients with permanent AF vs. 6.3% in 4 of 63 patients without, p < 0.0001). Lower heart/mediastinum ratio and lower left ventricular ejection fraction were the independent predictors of the transit to permanent AF with adjusted hazard ratios of 3.44 (95% confidence interval [CI]: 1.9 to 6.2, p < 0.0001) and 1.04 (95% CI: 1.01 to 1.08, p = 0.014). Further, these factors and higher plasma brain natriuretic peptide concentration were the independent predictors of the occurrence of HF with permanent AF, with adjusted hazard ratios of 5.08 (95% CI: 1.5 to 17.5, p = 0.011), 1.11 (95% CI: 1.03 to 1.19, p = 0.004), and 1.004 (95% CI: 1.001 to 1.008, p = 0.014).
  
  
  CONCLUSIONS
  cardiac SNS abnormality was associated with the occurrence of both HF and permanent AF in paroxysmal AF patients, and (123)I-mIBG imaging may be a useful modality for predicting the development of AF.
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Akutsu
authors.forename: Kyouichi
authors.initials: K
authors.lastname: Kaneko
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kodama
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Li
authors.forename: Jumpei
authors.initials: J
authors.lastname: Suyama
authors.forename: Akira
authors.initials: A
authors.lastname: Shinozuka
authors.forename: Takehiko
authors.initials: T
authors.lastname: Gokan
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hamazaki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000294:innervation*; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013564:Sympathetic Nervous System / Q000503:physiopathology*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine