The potential utility of (123)I-mIBG in atrial fibrillation and in the electrophysiology laboratory.

A novel indication for (123)I-mIBG has recently been proposed to risk stratify patients with atrial fibrillation. This review puts into perspective the utility and importance of such a risk stratification modality, in the setting of the epidemic of atrial fibrillation, which also relates to the prevalence of heart failure, obesity, hypertension, and stroke. The authors argue that the epic cost of care for patients with paroxysmal and more advanced forms of atrial fibrillation-including catheter ablation, heart failure, and stroke management-coupled with the poor efficacy of all treatment modalities in advanced atrial fibrillation, make necessary a paradigm shift where only paroxysmal atrial fibrillation that demonstrably will turn into permanent fibrillation should be targeted aggressively. If this premise is accepted, then (123)I-mIBG nuclear imaging for risk stratification becomes a vital tool for the care of the individual patient, as well as for disease control and cost containment in the population, since (123)I-mIBG scanning alone can predict (with hazard ratios of the order of 3.0-5.0) the future occurrence of permanent atrial fibrillation or heart failure.