title: Three-dimensional 123I-meta-iodobenzylguanidine cardiac innervation maps to assess substrate and successful ablation sites for ventricular tachycardia: feasibility study for a novel paradigm of innervation imaging.
abstract: BACKGROUND
  Innervation is a critical component of arrhythmogenesis and may present an important trigger/substrate modifier not used in current ventricular tachycardia (VT) ablation strategies.
  
  
  RESULTS
  Fifteen patients referred for ischemic VT ablation underwent preprocedural cardiac (123)I- meta-iodobenzylguanidine ((123)I-mIBG) imaging, which was used to create 3-dimensional (3D) innervation models and registered to high-density voltage maps. 3D (123)I-mIBG innervation maps demonstrated areas of complete denervation and (123)I-mIBG transition zone in all patients, which corresponded to 0% to 31% and 32% to 52% uptake. (123)I-mIBG denervated areas were ≈2.5-fold larger than bipolar voltage-defined scar (median, 24.6% [Q1-Q3, 18.3%-34.4%] versus 10.6% [Q1-Q3, 3.9%-16.4%]; P<0.001) and included the inferior wall in all patients, with no difference in the transition/border zone (11.4% [Q1-Q3, 9.5%-13.2%] versus 16.6% [Q1-Q3, 12.0%-18.8%]; P=0.07). Bipolar/unipolar voltages varied widely within areas of denervation (0.8 mV [Q1-Q3, 0.3-1.7 mV] and 4.0 mV [Q1-Q3, 2.9-5.6 mV]) and (123)I-mIBG transition zones (0.8 mV [Q1-Q3, 0.4-1.8 mV] and 4.6 mV [Q1-Q3, 3.2-6.3 mV]). Bipolar voltages in denervated areas and (123)I-mIBG transition zones were <0.5 mV, 0.5 to 1.5 mV, and >1.5 mV in 35%, 36%, and 29%, as well as 35%, 35%, and 30%, respectively (P>0.05). Successful ablation sites were within bipolar voltage-defined scar (7%), border zone (57%), and areas of normal voltage (36%), but all ablation sites were abnormally innervated (denervation/(123)I-mIBG transition zone in 50% each).
  
  
  CONCLUSIONS
  (123)I-mIBG innervation defects are larger than bipolar voltage-defined scar and cannot be detected with standard voltage criteria. Thirty-six percent of successful VT ablation sites demonstrated normal voltages (>1.5 mV), but all ablation sites were within the areas of abnormal innervation. (123)I-mIBG innervation maps may provide critical information about triggers/substrate modifiers and could improve understanding of VT substrate and facilitate VT ablation.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01250912.
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Klein
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abdulghani
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Mark
authors.initials: M
authors.lastname: Smith
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Rui
authors.initials: R
authors.lastname: Huang
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Ramazan
authors.initials: R
authors.lastname: Asoglu
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Remo
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Aharon
authors.initials: A
authors.lastname: Turgeman
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Olurotimi
authors.initials: O
authors.lastname: Mesubi
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Sunjeet
authors.initials: S
authors.lastname: Sidhu
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Synowski
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Anastasios
authors.initials: A
authors.lastname: Saliaris
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Vincent
authors.initials: V
authors.lastname: See
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Shorofsky
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Wengen
authors.initials: W
authors.lastname: Chen
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.).
authors.forename: Vasken
authors.initials: V
authors.lastname: Dilsizian
authors.affiliation: From the Maryland Arrhythmia and Cardiology Imaging Group (MACIG) (T.K., M.A., M.S., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., W.C., V.D., T.D.), Division of Cardiology (T.K., M.A., R.H., R.A., B.F., O.M., S.S., S.S., A.S., V.S., S.S., T.D.), Department of Radiology (M.S., W.C., V.D.), University of Maryland, Baltimore; and Biosense Webster, Haifa, Israel (A.T.). tdickfel@medicine.umaryland.edu.
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
mesh_terms: D019797:3-Iodobenzylguanidine; D000200:Action Potentials; D000368:Aged; D000465:Algorithms; D015142:Baltimore; D017115:Catheter Ablation / Q000009:adverse effects; D022062:Electrophysiologic Techniques, Cardiac; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000294:innervation / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
keywords: cardiac imaging techniques; innervation; tachycardia, ventricular