{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:23:22Z","timestamp":1760235802439,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:00:00Z","timestamp":1632960000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["SFB656-C11"],"award-info":[{"award-number":["SFB656-C11"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Pulmonary vein isolation (PVI) and antiarrhythmic drug therapy are established treatment strategies to preserve sinus rhythm in atrial fibrillation (AF). However, the efficacy of both interventional and pharmaceutical therapy is still limited. Solid evidence suggests an important role of the cardiac sympathetic nervous system in AF. In this blinded, prospective observational study, we studied left ventricular cardiac sympathetic activity in patients treated with PVI and with antiarrhythmic drugs. Prospectively, Iodine-123-benzyl-guanidine single photon emission computer tomography (123I-mIBG-SPECT) was performed in a total of 23 patients with paroxysmal AF, who underwent PVI (n = 20) or received antiarrhythmic drug therapy only (n = 3), respectively. 123I-mIBG planar and SPECT\/CT scans were performed before and 4 to 8 weeks after PVI (or initiation of drug therapy, respectively). For semiquantitative SPECT image analysis, attenuation-corrected early\/late images were analyzed. Quantitative SPECT analysis was performed using the AHA 17-segment model of the left ventricle. Results: PVI with point-by-point radiofrequency ablation led to a significantly (p &lt; 0.05) higher visual sympathetic innervation defect score when comparing pre-and post PVI. Newly emerging innervation deficits post PVI were localized predominantly in the inferior lateral wall. These findings were corroborated by semiquantitative SPECT analysis identifying inferolateral segments with a reduced tracer uptake in comparison to SPECT before PVI. Following PVI, patients with an AF relapse showed a different sympathetic innervation pattern compared to patients with sufficient rhythm control. Conclusions: PVI results in novel defects of cardiac sympathetic innervation. Differences in cardiac sympathetic innervation remodelling following PVI suggest an important role of the cardiac autonomous nervous system in the maintenance of sinus rhythm following PVI.<\/jats:p>","DOI":"10.3390\/jpm11100995","type":"journal-article","created":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T10:55:40Z","timestamp":1633085740000},"page":"995","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac Sympathetic Activity and Rhythm Control Following Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation\u2014A Prospective 123I-mIBG-SPECT\/CT Imaging Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Philipp S.","family":"Lange","sequence":"first","affiliation":[{"name":"Department of Cardiology II (Electrophysiology), University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Wenning","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital M\u00fcnster, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8514-326X","authenticated-orcid":false,"given":"Nemanja","family":"Avramovic","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital M\u00fcnster, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Leitz","sequence":"additional","affiliation":[{"name":"Department of Cardiology II (Electrophysiology), University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1413-5152","authenticated-orcid":false,"given":"Robert","family":"Larbig","sequence":"additional","affiliation":[{"name":"Department of Cardiology II (Electrophysiology), University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1431-9886","authenticated-orcid":false,"given":"Gerrit","family":"Frommeyer","sequence":"additional","affiliation":[{"name":"Department of Cardiology II (Electrophysiology), University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Sch\u00e4fers","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital M\u00fcnster, D-48149 M\u00fcnster, Germany"},{"name":"European Institute for Molecular Imaging, University of M\u00fcnster, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"Eckardt","sequence":"additional","affiliation":[{"name":"Department of Cardiology II (Electrophysiology), University Hospital M\u00fcnster, Albert-Schweitzer-Campus 1, D-48149 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1161\/CIRCULATIONAHA.113.005119","article-title":"Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study","volume":"129","author":"Chugh","year":"2014","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1080\/17434440.2017.1358086","article-title":"The quest for durable lesions in catheter ablation of atrial fibrillation\u2014Technological advances in radiofrequency catheters and balloon devices","volume":"14","author":"Maurer","year":"2017","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.jacc.2014.06.1172","article-title":"Atrial fibrillation ablation: Translating basic mechanistic insights to the patient","volume":"64","author":"Nishida","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/j.jacc.2016.06.036","article-title":"Ganglion Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study","volume":"68","author":"Driessen","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1111\/pace.12957","article-title":"Impact of Anatomically Guided Ganglionated Plexus Ablation on Electrical Firing from Isolated Pulmonary Veins","volume":"39","author":"Jiang","year":"2016","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.hrthm.2013.04.016","article-title":"Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent\/long-standing persistent atrial fibrillation: A randomized comparison","volume":"10","author":"Pokushalov","year":"2013","journal-title":"Heart Rhythm"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s00595-018-1672-5","article-title":"Is ganglionated plexus ablation effective for treating atrial fibrillation?","volume":"48","author":"Watanabe","year":"2018","journal-title":"Surg. Today"},{"key":"ref_8","first-page":"904","article-title":"Kinetics of 123I-MIBG after acute myocardial infarction and reperfusion therapy","volume":"40","author":"Bengel","year":"1999","journal-title":"J. Nucl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1038\/s41569-019-0221-2","article-title":"The autonomic nervous system and cardiac arrhythmias: Current concepts and emerging therapies","volume":"16","author":"Herring","year":"2019","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1111\/j.1540-8167.2011.02123.x","article-title":"High washout rate of iodine-123-metaiodobenzylguanidine imaging predicts the outcome of catheter ablation of atrial fibrillation","volume":"22","author":"Arimoto","year":"2011","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ijcard.2015.07.028","article-title":"Impact of atrial fibrillation ablation on cardiac sympathetic nervous system in patients with and without heart failure","volume":"199","author":"Masuda","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/2191-219X-3-81","article-title":"Pulmonary vein isolation in patients with paroxysmal atrial fibrillation is associated with regional cardiac sympathetic denervation","volume":"3","author":"Wenning","year":"2013","journal-title":"EJNMMI Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1007\/s00259-010-1491-4","article-title":"Committee EC and European Council of Nuclear, C. Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology","volume":"37","author":"Flotats","year":"2010","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_14","first-page":"712","article-title":"A new algorithm for the quantitation of myocardial perfusion SPECT. I: Technical principles and reproducibility","volume":"41","author":"Germano","year":"2000","journal-title":"J. Nucl. Med."},{"key":"ref_15","first-page":"720","article-title":"A new algorithm for the quantitation of myocardial perfusion SPECT. II: Validation and diagnostic yield","volume":"41","author":"Sharir","year":"2000","journal-title":"J. Nucl. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1007\/s00259-006-0322-0","article-title":"Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: Validation of an elastic surface model approach in comparison to cardiac magnetic resonance imaging, 4D-MSPECT and QGS","volume":"34","author":"Stegger","year":"2007","journal-title":"Eur J. Nucl. Med. Mol. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.hrthm.2006.12.006","article-title":"Autonomic nerve activity and atrial fibrillation","volume":"4","author":"Chen","year":"2007","journal-title":"Heart Rhythm"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3389\/fphys.2018.00240","article-title":"Synaptic Plasticity in Cardiac Innervation and Its Potential Role in Atrial Fibrillation","volume":"9","author":"Ashton","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJMoa1707855","article-title":"Catheter Ablation for Atrial Fibrillation with Heart Failure","volume":"378","author":"Marrouche","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2478","DOI":"10.1093\/eurheartj\/ehw087","article-title":"Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death: Data from Swedish health registries","volume":"37","author":"Friberg","year":"2016","journal-title":"Eur. Hear. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1007\/s12350-015-0108-5","article-title":"I-123 MIBG Cardiac Imaging","volume":"22","author":"Soman","year":"2015","journal-title":"J. Nucl. Cardiol."},{"key":"ref_22","first-page":"1967","article-title":"Coincidental ganglionated plexus modification during radiofrequency pulmonary vein isolation and post-ablation arrhythmia recurrence","volume":"19","author":"Giannopoulos","year":"2016","journal-title":"Europace"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.hrthm.2016.08.038","article-title":"I-123-Metaiodobenzylguanidine imaging in patients with atrial fibrillation undergoing cardiac mapping and ablation of autonomic ganglia","volume":"14","author":"Lemery","year":"2017","journal-title":"Hearth Rhythm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1007\/s12350-015-0066-y","article-title":"Direct visualization of regional cardiac sympathetic dysfunction in stress-induced cardiomyopathy","volume":"22","author":"Harris","year":"2015","journal-title":"J. Nucl. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s00259-007-0639-3","article-title":"I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: Insights from a retrospective European multicenter study","volume":"35","author":"Agostini","year":"2008","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jcmg.2009.07.014","article-title":"Cardiac Sympathetic Imaging With mIBG in Heart Failure","volume":"3","author":"Cowie","year":"2010","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s12149-007-0062-7","article-title":"Prognostic value of 123I-metaiodobenzylguanidine in patients with various heart diseases","volume":"21","author":"Nagamatsu","year":"2007","journal-title":"Ann. Nucl. 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