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Title: Correlation of scintigraphic phase maps with intraoperative epicardial/endocardial maps in patients with activation disturbances

Abstract

To assess the true accuracy of scintigraphic findings, 8 patients (PTS), 6 with pre-excitation (PEX) syndrome and 2 with intractable ventricular tachycardia (VT), were studied by phase analysis, prior to corrective surgery. Sites of earliest phase angle were determined in multiple projections during the conduction disturbance, compared to sites of early ventricular activation determined by epicardial mapping during PEX and, when performed, by endocardial mapping during VT, and to maps previously generated at conventional electrophysiologic study (EPS). Among PEX PTS, Rt and Lt lateral, Lt anterolateral, Rt and Lt posterolateral and posteroseptal bypass pathways mapped at surgery correlated with phase localization. While localization from EPS also correlated well with surgical maps in 4 PTS, 1 PT could not be mapped by EPS and another presented ambiguities. Scintigraphic localization also correlated well with surgical mapping in a PT with a RV VT focus while EPS was suggestive but uncertain. A second PT with VT mapped scintigraphically to originate in a Lt lateral focus, demonstrated a similar localization on EPS, and during surgical mapping, an incision made through the scintigraphic focus terminated VT. Incision in regions of earliest activity in the first VT PT and in PTS with PEX resolved the arrhythmiamore » or interrupted the bypass tract. Phase mapping correlated closely with surface mapping at surgery while providing an accurate, independent method for noninvasive assessment of conduction disturbances and a complementary tool to standard EPS.« less

Authors:
; ; ; ; ; ; ; ;
Publication Date:
Research Org.:
Univ. of California, San Francisco, CA
OSTI Identifier:
6844826
Report Number(s):
CONF-840619-
Journal ID: CODEN: JNMEA; TRN: 87-008780
Resource Type:
Conference
Resource Relation:
Journal Name: J. Nucl. Med.; (United States); Journal Volume: 25:5; Conference: 31. annual meeting of the Society of Nuclear Medicine, Los Angeles, CA, USA, 5 Jun 1984
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; HEART; SCINTISCANNING; SURGERY; DISTURBANCES; INCIDENCE ANGLE; MAPPING; MAPS; PATIENTS; BODY; CARDIOVASCULAR SYSTEM; COUNTING TECHNIQUES; DIAGNOSTIC TECHNIQUES; MEDICINE; ORGANS; RADIOISOTOPE SCANNING 550601* -- Medicine-- Unsealed Radionuclides in Diagnostics

Citation Formats

Dae, M.W., Botvinick, E.H., Scheinmann, M.H., Morady, F.J., Davis, J.A., Schechtmann, N., Frais, M., Faulkner, D., and O'Connell, W.. Correlation of scintigraphic phase maps with intraoperative epicardial/endocardial maps in patients with activation disturbances. United States: N. p., 1984. Web.
Dae, M.W., Botvinick, E.H., Scheinmann, M.H., Morady, F.J., Davis, J.A., Schechtmann, N., Frais, M., Faulkner, D., & O'Connell, W.. Correlation of scintigraphic phase maps with intraoperative epicardial/endocardial maps in patients with activation disturbances. United States.
Dae, M.W., Botvinick, E.H., Scheinmann, M.H., Morady, F.J., Davis, J.A., Schechtmann, N., Frais, M., Faulkner, D., and O'Connell, W.. 1984. "Correlation of scintigraphic phase maps with intraoperative epicardial/endocardial maps in patients with activation disturbances". United States. doi:.
@article{osti_6844826,
title = {Correlation of scintigraphic phase maps with intraoperative epicardial/endocardial maps in patients with activation disturbances},
author = {Dae, M.W. and Botvinick, E.H. and Scheinmann, M.H. and Morady, F.J. and Davis, J.A. and Schechtmann, N. and Frais, M. and Faulkner, D. and O'Connell, W.},
abstractNote = {To assess the true accuracy of scintigraphic findings, 8 patients (PTS), 6 with pre-excitation (PEX) syndrome and 2 with intractable ventricular tachycardia (VT), were studied by phase analysis, prior to corrective surgery. Sites of earliest phase angle were determined in multiple projections during the conduction disturbance, compared to sites of early ventricular activation determined by epicardial mapping during PEX and, when performed, by endocardial mapping during VT, and to maps previously generated at conventional electrophysiologic study (EPS). Among PEX PTS, Rt and Lt lateral, Lt anterolateral, Rt and Lt posterolateral and posteroseptal bypass pathways mapped at surgery correlated with phase localization. While localization from EPS also correlated well with surgical maps in 4 PTS, 1 PT could not be mapped by EPS and another presented ambiguities. Scintigraphic localization also correlated well with surgical mapping in a PT with a RV VT focus while EPS was suggestive but uncertain. A second PT with VT mapped scintigraphically to originate in a Lt lateral focus, demonstrated a similar localization on EPS, and during surgical mapping, an incision made through the scintigraphic focus terminated VT. Incision in regions of earliest activity in the first VT PT and in PTS with PEX resolved the arrhythmia or interrupted the bypass tract. Phase mapping correlated closely with surface mapping at surgery while providing an accurate, independent method for noninvasive assessment of conduction disturbances and a complementary tool to standard EPS.},
doi = {},
journal = {J. Nucl. Med.; (United States)},
number = ,
volume = 25:5,
place = {United States},
year = 1984,
month = 1
}

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  • To validate the accuracy of scintigraphic phase analysis in characterizing ventricular (V) activation patterns, and to gain insight into electromechanical coupling, the authors studied 12 activation sequences during atrial and right and left (V) pacing in 4 normal dogs. For each sequence, phase maps generated from equilibrium blood pool scintigrams in multiple projections were compared to epicardial (E) maps obtained from a roving bipolar electrode after thoracotomy. Thirty to forty sites were recorded and referenced to 2 intracardiac and 2 surface electrograms for each sequence. Pacing catheters were kept stationary during phase and (E) mapping. In 11/12 sequences (E) breakthroughmore » and site of earliest contraction (phase angle) occurred in the same region. Areas with secondary breakthrough showed islands of early contraction. Sequences were comparable in direction of spread, and location of terminal activity. Regions of synchronous excitation were comparable in distribution to regions with homogeneous contraction. In 1/12 the phase map showed fusion due to competing sinus and (V) pacing rates, while the later (E) map reflected only (V) pacing. Phase sequences closely follow (E) activation patterns in normal hearts, and provide a unique method of characterizing the interaction of electrical and mechanical events.« less
  • The false negative rate of ventilation-perfusion (V-P) scintigraphy for PE increases in the presence of widespread obstructive pulmonary disease (OPD) because diffuse V abnormalities conceal potential V-P mismatches. To determine whether this situation could be predicted accurately by a pre-scintigraphy chest x-ray (CXR), a double-blind evaluation of 55 CXRs and V-P scans in 53 patients (pts) was performed. Multiview Kr-81m (Kr) scans were done in 38 cases and pre-perfusion Xe-133 (Xe) studies including washout in 17. All CXRs were obtained within 24 hrs of the scans and none showed infiltrates that would otherwise render the V-P scan nondiagnostic (NDX). Allmore » V-P scans showing V abnormalities in greater than or equal to67% of the lung fields were considered NDX, and those showing V abnormalities in 50-67% of the lungs were considered ''borderline'' for interpretation. CXRs were classified as showing diffuse OPD, focal OPD, or as no evidence for OPD. All V and all P scans were abnormal; 7 cases were read as high probability for PE, 29 as low probability and the remainder as NDX. Eleven of 13 (85%) pts with diffuse OPD by CXR had NDX scans (8/9 Kr, 3/4 Xe) and two were considered borderline. However, none of 10 pts with focal OPD by CXR had NDX scans and only 2 were considered borderline. The CXR showed no OPD in 32 cases, but 8 (25%) had enough V abnormalities to be classified NDX (2 of 21 Kr scans, 6 0f 11 Xe scans) and 2 others (both Kr scans) were considered borderline. The findings confirm that V scintigraphy with either Kr or Xe is more sensitive than the CXR in detecting airways disease, but indicate that V-P scintigraphy is likely to be NDX for PE in pts whose CXRs demonstrate diffuse OPD.« less
  • Oropharyngeal tumors are routinely treated with extensive surgical resection and radiotherapy followed by PM and DP myocutaneous flaps performed for reconstruction purposes. The lymph vessels are the main pathways of oropharyngeal tumor dissemination and play an important role in the development of local recurrences and regional tumor invasion. To evaluate the local and regional residual pathways of lymphatic drainage after flap reconstruction, 25 pts (pts) were imaged 2-3 hours post-administration of .5 mCi of Tc-99m antimony colloid in the flaps. All pts had extensive tumor resection and PM (21 pts) or DP (4 pts) flaps. Fifteen pts had neck radiotherapymore » prior to the scintigrams. Following are the scintigraphic findings: 1) eight pts showed no visualization of lymph nodes although 4 of these had radiocolloid accumulation within the liver; 2) contralateral or ipsilateral cervical lymph nodes were seen in 16 pts; 3) xyphoid or internal mammary nodes were seen in 4 pts; 4) axillary nodes were seen in 5 pts; 5) liver visualization was present in 12 pts. Findings indicate that pathways of lymph drainage re-establish following head and neck surgery and flap reconstruction in most pts. These pathways are variable and unpredictable and lymphoscintigraphy may therefore play a major role to predict sites of future metastases and in planning therapy.« less
  • Diffuse disturbance in gastrointestinal motility may be present in patients with irritable bowel syndrome (IBS). To further investigate small intestinal motility in IBS patients small intestinal transit time (SITT) was determined and related to the symptom status. 11 female patients with IBS (mean age 29 years) were divided into those whose predominate symptom was diarrhea (N=6), and those with only constipation (N=5). All subjects ingested an isosmotic solution of lactulose (10 gm in 150cc of water) labeled with 99m-Tc-DTPA (Sn). The patient was studied supine under a 25 inch gamma camera with data collected at 1 frame per minute formore » 180 minutes or until activity appeared in the ascending colon. Regions of interest were selected over the cecum and ascending colon. The time of first appearance of radioactivity in the region of the cecum was taken as the small intestinal transit time. SITT in the 5 normal females was 98.7 +- 13 min (mean +- SEM). SITT in the IBS patients with diarrhea, 67.3 +- 7 min was significantly faster (p< 0.08). SITT in the constipated IBS patients, 126 +- 12 min, was slower than normals and significantly different from diarrhea patients (p< 0.001). These studies show that IBS patients with diarrhea have significantly faster SITT than normals while constipated IBS patients have significantly slower SITT than the diarrhea subgroup. Further, this study emphasizes the need to study the various symptomatic subgroups of IBs patients independently and indicates a possible role for abnormal SITT in the pathogenesis of IBS.« less