Volume 14, Issue 1, Pages (January 2017)

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Volume 14, Issue 1, Pages 128-132 (January 2017) I-123-Metaiodobenzylguanidine imaging in patients with atrial fibrillation undergoing cardiac mapping and ablation of autonomic ganglia Robert Lemery, MD, FHRS, Shlomo Ben-Haim, MD, DSc, Glenn Wells, PhD, Terrence D. Ruddy, MD Heart Rhythm Volume 14, Issue 1, Pages 128-132 (January 2017) DOI: 10.1016/j.hrthm.2016.08.038 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Mapping of ganglionated plexus with use of high-frequency stimulation in patient 3. During delivery of 5 V to the anterior region of the right upper pulmonary vein, the patient had bradycardia/asystole with no blood pressure at that time. Heart Rhythm 2017 14, 128-132DOI: (10.1016/j.hrthm.2016.08.038) Copyright © 2016 The Authors Terms and Conditions

Figure 2 I-123-metaiodobenzylguanidine (MIBG) imaging in patient 1. The usual polar views are shown on the left and the corresponding 17-segment summation scores on the right. The images show the findings preablation as well as early and late postablation. In this patient, the preablation scan revealed only a very small defect, not inclusive of a segment, with a score of 0. The early postablation scan clearly shows a deficit corresponding to a lack of MIBG uptake to a region scored as 1. The late postablation scan shows that the deficit has moved slightly with the same deficit score. ANT = anterior; INF = inferior; LAT = lateral; SEP = septal; SRS = summed rest score. Heart Rhythm 2017 14, 128-132DOI: (10.1016/j.hrthm.2016.08.038) Copyright © 2016 The Authors Terms and Conditions

Figure 3 A: Short-axis (SA) apex to base slices of the left ventricle 4 hours after the injection of I-123-metaiodobenzylguanidine (MIBG) in patient 5. The images were obtained preablation as well as early and late postablation. A new innervation defect is indicated with the white arrow. B: MIBG imaging in patient 5. In this patient, the preablation scan shows a moderate defect with a score of 8. The early postablation scan clearly shows an enlarged and more pronounced deficit corresponding to a lack of MIBG uptake to a region scored as 18. The late postablation shows that the deficit is slightly more pronounced. The LV myocardial site of denervation could possibly be consistent with injury from ablation to the sympathetic left lateral cardiac nerve.11 ANT = anterior; INF = inferior; LAT = lateral; SEP = septal; SRS = summed rest score. Heart Rhythm 2017 14, 128-132DOI: (10.1016/j.hrthm.2016.08.038) Copyright © 2016 The Authors Terms and Conditions