title: Usefulness of severe cardiac sympathetic dysfunction to predict the occurrence of rapid atrial fibrillation in patients with Wolff-Parkinson-White syndrome.
abstract: Atrial fibrillation (AF) can be a potentially life-threatening arrhythmia when it conducts rapidly through the accessory pathway, which was not predicted by the noninvasive method. We evaluated the cardiac sympathetic activity for predicting the occurrence of AF in patients with Wolff-Parkinson-White (WPW) syndrome. Iodine-123 metaiodobenzylguanidine scintigraphy was performed under stable sinus rhythm conditions at rest <1 week before an electrophysiologic study (EPS) to assess the sympathetic activity using the heart/mediastinum (H/M) ratio in 45 consecutive patients with WPW who had a history of supraventricular tachycardia (mean ± SD, age: 47 ± 17 years, 42.2% women). The study also included 15 normal healthy volunteers (56 ± 17 years, 40% women). The H/M ratio was lower in patients with WPW syndrome than in the normal control group, and in the 15 patients with AF induced during EPS than in the 30 patients without AF (p <0.0001). The sensitivity of H/M ratio ≤2.8 for predicting the AF induced during EPS was 75% in 12 of 16 patients, and the specificity was 89.7% in 26 of 29 patients. The H/M ratio was positively correlated with anterograde effective refractory period (r = 0.514, p <0.0001). The sensitivity of H/M ratio ≤2.75 for predicting the AF with a short anterograde effective refractory period (≤250 ms) was 91.7% in 11 of 12 patients, and the specificity was 90.9% in 30 of 33 patients. In conclusion, the severe cardiac sympathetic dysfunction was associated with the occurrence of AF, particularly in those with rapid AF and in patients with WPW syndrome.
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan. hzn01233@s02.itscom.net
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: Taku
authors.initials: T
authors.lastname: Asano
authors.forename: Jumpei
authors.initials: J
authors.lastname: Suyama
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Atsuo
authors.initials: A
authors.lastname: Namiki
authors.forename: Akira
authors.initials: A
authors.lastname: Shinozuka
authors.forename: Takehiko
authors.initials: T
authors.lastname: Gokan
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D019797:3-Iodobenzylguanidine; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000294:innervation*; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging*; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000000981:diagnostic imaging*; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine