Dr. Nico Bruining,
A nice overview was presented from basic science, e.g. the morphology of the nerve system, to clinical application using various imaging modalities to visualize this system in humans and how that could be of assistance in later treatment. Dr. Ho from Imperial College in London, UK started this session by showing us the morphology of the nerve system in the heart. During a nice informative movie, an explanted heart was dissected and the nerve system was identified. The location and the correct identification of the nerve system are of course of utmost importance for later treatment. Therefore, this presentation was very instructive. For more information, I would encourage you to look up the work of Dr. Ho and colleagues (name for Pubmed: Ho, S.Y.). The second speaker, Dr. Law from Munster, Germany, showed us the strengths of PET imaging and she explained carefully what is necessary to perform this kind of imaging. In her own words: Sudden heart death occurs without warning. At autopsy, 88% of cases show anatomical changes in the heart but in others there are no signs of structural damage. PET imaging of cardiac innervation may help to understand the underlying causes of these deaths and to predict those individuals who are at risk. Studies of patients with arrhythmias but no clinical signs of heart failure indicate that there are decreases in both presynaptic and postsynaptic functions of the cardiac sympathetic nervous system, in hypertrophic cardiomyopathy (HCM), Idiopathic ventricular tachycardia / fibrillation (iVT, iVF) and arrhythmogenic right ventricular cardiomyopathy (ARVCM) but not in Brugada syndrome. The use of small animal PET offers the chance to study cardiac innervation in transgenic mouse models of human arrhythmias. Dr. Le Guludec, from Paris, France, showed how nuclear MIBG scintigraphy is being applied to visualize the nerve system. She presented studies in which this imaging modality can identify nicely those patients suffering from chronic heart failure, who might need an implantable defibrillator due to the fact of a high likelihood of having a period of arrhythmias. Much research is still on-going to find a way to match pre-clinical animal models with human pathologies. The final speaker of this session, Dr. Wijnmaalen, from Leiden, The Netherlands, showed us the multi-modality imaging of contrast-enhanced MRI and voltage mapping, to be used for later treatment planning. Although currently still a research tool only, and recently reported in the European Heart Journal, the results are looking encouraging and could trigger, hopefully, the device industry to develop systems in which multi-modality imaging would be more practical. It still takes hours to evaluate the data of a single patient. However, he made it clear that contrast-enhanced MRI is superior to normal MRI in identifying scarred regions of the myocardium. This is nicely validated in animal models. The voltage mapping systems have already been in use for many years and their valuable attribution in catheter ablation has already been proven in the past. Merging these two modalities gives the electrophysiologist a potentially powerful treatment planning system. Using these modalities, they also investigated if a region of myocardial damaged tissue could be affected by re-occurring arrhythmias. We are looking forward to the further progress of this exciting new fused modality.
Neurocardiac imaging: at the heart of electrical disturbances
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