Yu.B. Lishmanov (1,2), Yu.V. Saushkina (1), S.M. Minin (1), I.Yu. Efimova (1), I.V. Kisteneva (1), S.V. Popov (1) 1 -Research Institute for Cardiology, Kievskaya str., 111a, Tomsk, Russian Federation, 634012; 2 -National Research Tomsk Polytechnic University, Pr. Lenina, 30, Tomsk, Russian Federation, 634050

Introduction. To date, the mechanisms underlying the majority of cardiac arrhythmias are unclear. The disturbance of sympathetic innervation of the heart may be as well the cause of atrial fibrillation (AF), as the reason of myocardial dysfunction of the left ventricle. The aim of the study. The assessment of cardiac sympathetic activity and myocardial perfusion in patients with atrial fibrillation by scintigraphy with 123I-metaiodbenzilguanidine (123I-MIBG) and 99mTc-MIBI, respectively. Methods. The study included 40 patients with suspected coronary artery disease, class 3 hypertension. All patients were divideв into 3 groups: 15 patients - with paroxysmal AF (PAF), 15 patients – with long-standing persistent AF (LSPAF) and 10 patients – with sinus rhythm (SR). All patients were underwent SPECT with 123I-MIBG and 99mTc-MIBI to evaluate of cardiac sympathetic activity and myocardial perfusion, respectively. Results. In both patients with PAF and LSPAF the early H/M ratio and delayed H/M ratio was significantly lower if compared to patients with SR. The washout rate of 123I-MIBG in both patients with PAF and LSPAF was greater if compared to patients with SR. However, both early and delayed SPECT images showed that the sympathetic activity defect was significantly more pronounceв in patients with LSPAF when compared to patients with PAF and patients with SR. Conclusions. The most sympathetic innervation abnormality was observed in patients with atrial fibrillation. The atrial fibrillation has no significant effect on myocardial perfusion. The most significant violation of the regional cardiac sympathetic activity was observed in patients with LSPAF.
atrial fibrillation, 123I-MIBG, sympathetic innervation, 99mTc-MIBI

Список литературы: 
  1. Allessie M.A., Boyden P.A., Camm A.J., Kléber A.G., Lab M.J., Legato M.J., Rosen M.R., Schwartz P.J., Spooner P.M., Van Wagoner D.R., Waldo A.L. Pathophysiology and prevention of atrial fibrillation. Circulation. 2001; 103 (5): 769–77.
  2. Cannata D., Narbone N.B. Clinical observations on the role of the vegetative nervous system in the pathogenesis of atrial fibrillation. Cardiologia. 1958; 32 (6): 329–45.
  3. Chen J., Wasmund S.L., Hamdan M.H. Back to the future: the role of the autonomic nervous system in atrial fibrillation. Pacing Clin. Electrophysiol. 2006; 29 (4): 413–21.
  4. Sharifov O.F., Fedorov V.V., Beloshapko G.G., Glukhov A.V., Yushmanova A.V., Rosenshtraukh L.V. Roles of adrenergic and cholinergic stimulation in spontaneous atrial fibrillation in dogs. J Am Coll Cardiol. 2004; 43 (3): 483–90.
  5. Abidov A., Hachamovitch R., Rozanski A., Hayes S.W., Santos M.M., Sciammarella M.G., Cohen I., Gerlach J., Friedman J.D., Germano G., Berman D.S. Prognostic implications of atrial fibrillation in patients undergoing myocardial perfusion single-photon emission computed tomography. J. Am. Coll. Cardiol. 2004; 44 (5): 1062–70.
  6. Akutsu Y., Kaneko K., Kodama Y., Li H.L., Suyama J., Shinozuka A., Gokan T., Kawamura M., Asano T., Hamazaki Y., Tanno K., Kobayashi Y. Significance of cardiac sympathetic nervous system abnormality for predicting vascular events in patients with idiopathic paroxysmal atrial fibrillation. Eur. J. Nucl. Med. Mol. Imaging. 2010; 37 (4): 742–9.
  7. Arora R. Sympathetic imaging with 123-I-MIBG – a new way to predict recurrences after AF ablation. J. Cardiovasc Electrophysiol. 2011; 22 (12): 1305–8.
  8. Goette A., Bukowska A., Dobrev D., Pfeiffenberger J., Morawietz H., Strugala D., Wiswedel I., Röhl F.W., Wolke C., Bergmann S., Bramlage P., Ravens U., Lendeckel U. Acute atrial tachyarrhythmia induces angiotensin II type 1 receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur. Heart. J. 2009; 30 (11): 1411–20.
  9. Arimoto T., Tada H., Igarashi M., Sekiguchi Y., Sato A., Koyama T., Yamasaki H., Machino T., Kuroki K., Kuga K., Aonuma K. High washout rate of iodine-123-metaiodobenzylguanidine imaging predicts the outcome of catheter ablation of atrial fibrillation. J. Cardiovasc Electrophysiol. 2011; 22 (12): 1297–304.
  10. Minin S.M., Efimova I.Yu., Saushkina Yu.V., Sazonova S.I. Ispol`zovanie radiofarmpreparatov na osnove 123I v ocenke narusheniy simpaticheskoy innervacii i metabolizma miokarda. Rossiyskiy medicinskiy zhurnal. 2013; 1: 49–52. [Minin S.M., Efimova I.Yu., Saushkina Yu.V., Sazonova S.I. Using radiopharmaceuticals 123-iodine in assessing breaches of the sympathetic innervation and myocardial metabolism.Russian journal of medicine. 2013; 1: 49–52 (in Russian)]
  11. Wieland D.M., Brown L.E., Rogers W.L., Worthington K.C., Wu J.L., Clinthorne N.H., Otto C.A., Swanson D.P., Beierwaltes W.H. Myocardial imaging with a radioiodinated norepinephrine storage analog. J. Nucl. Med. 1981; 22 (1): 22–31.
  12. Lishmanov Yu.B., Chernov V.I. Scintigrafiya miokarda v yadernoy kardiologii. Tomsk: TGU; 1997. [Lishmanov Yu.B., Chernov V.I. Scintigraphy of myocardium in nuclear cardiology. Tomsk: TSU; 1997 (in Russian)]
  13. Grishaev S.L., Tkachenko K.N., Svistov A.S., Nikiforov V.S., Suhov V.Yu. Vozmozhnosti OFE`KT v ocenke simpaticheskoy aktivnosti miokarda u bol`nyh s postoyannoy fibrillyaciey predserdiy. Vestnik aritmologii. 2011; 63: 12–5. [Grishaev S.L., Tkachenko K.N., Svistov A.S., Nikiforov V.S., Suhov V.Yu. Opportunities SPECT in the evaluation of cardiac sympathetic activity in patients with permanent atrial fibrillation. Bulletin of Arrhythmology. 2011; 63: 12–5 (in Russian)]
  14. Nucifora G., Schuijf J.D., van Werkhoven J.M., Trines S.A., Kajander S., Tops L.F., Turta O., Jukema J.W., Schreur J.H., Heijenbrok M.W., Gaemperli O., Kaufmann P.A., Knuuti J., van der Wall E.E., Schalij M.J., Bax J.J. Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation. Int. J. Cardiovasc Imaging. 2011; 27 (6): 777–85.
  15. Siegrist P.T., Gaemperli O., Koepfli P., Schepis T., Namdar M., Valenta I., Aiello F., Fleischmann S., Alkadhi H., Kaufmann P.A. Repeatability of cold pressor test-induced flow increase assessed with H(2)(15)O and PET. J. Nucl. Med. 2006; 47 (9): 1420–6.
  16. Zeiher A.M., Drexler H., Wollschlaeger H., Saurbier B., Just H. Coronary vasomotion in response to sympathetic stimulation in humans: importance of the functional integrity of the endothelium. J. Am. Coll. Cardiol. 1989; 14 (5): 1181–90.
  17. Aronow W.S., Ahn C., Mercando A.D., Epstein S. Correlation of atrial fibrillation, paroxysmal supraventricular tachycardia, and sinus rhythm with incidences of new coronary events in 1, 359 patients, mean age 81 years, with heart disease. Am J Cardiol. 1995; 75: 182–4.
  18. Miyasaka Y., Barnes M.E., Gersh B.J., Cha S.S., Bailey K.R., Seward J.B., Iwasaka T., Tsang T.S. Coronary ischemic events after first atrial fibrillation: risk and survival. Am. J. Med. 2007; 120: 357–63.