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Clinical predictors and implications of cardiac inflammation detected on positron emission tomography (PET) in patients referred for premature ventricular complex (PVC) ablation

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Abstract

Background

Positron emission tomography computed tomography (PET-CT) is not routinely used for premature ventricular complexes (PVCs). Whether specific clinical factors are associated with abnormal PET-CT results is not clear.

Methods

The treatment courses and baseline characteristics of consecutive patients in a single center between 2012 and 2021, age > 18 years old, and who received 18F-fluorodeoxyglucose (FDG) PET-CT imaging for evaluation of PVCs were retrospectively analyzed.

Results

A total of 102 patients was included. Of these, 27 patients (26.4%) had abnormal PET-CT and 61 (59.8%) had normal imaging. Abnormal PET-CT findings were associated with non-sustained ventricular tachycardia (NSVT) (95.2% vs. 52.6%, p = 0.001), higher number of PVC morphologies (2.29 ± 0.7 vs. 1.31 ± 0.6, p < 0.001), greater PVC coupling interval dispersion (72.47 ± 66.4 ms vs. 13.42 ± 17.9 ms, p < 0.001), and greater likelihood of fast heart rate dependent PVCs (78.5% vs. 38.2%, p = 0.017). Fourteen (51.8%) patients had an abnormal PET-CT and abnormal late gadolinium enhancement (LGE). Patients with abnormal PET-CT were more frequently treated with immunosuppression (81.4% vs. 3.2%, p < .0001) than with catheter ablation (11.1% vs. 45.9%, p = 0.002) compared to the normal PET-CT group. Over a median follow-up of 862 days (IQR 134, 1407), PVC burden decreased in both groups [from 23 ± 16% to 9 ± 10% (p < 0.001) in abnormal PET-CT group and from 21 ± 15% to 7 ± 10% (p < 0.001) in normal PET-CT group].

Conclusions

Abnormal PET-CT findings were more commonly associated with NSVT, multiform PVCs, greater PVC coupling interval dispersion, and fast heart rate dependent PVCs. LGE was not sensitive for detecting inflammation. Immunosuppression was effective in managing PVCs with abnormal PET-CT.

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Funding

This study was supported by NHLBI grant R01HL084261 (to Kalyanam Shivkumar and Jason Bradfield).

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Author notes

  1. Wei-Hsin Chung and Justin Hayase contributed equally to this work.

Authors and Affiliations

  1. UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA

    Wei-Hsin Chung, Justin Hayase, Duc H. Do, Neal Dixit, Olujimi Ajijola, Eric Buch, Noel Boyle, Kalyanam Shivkumar & Jason S. Bradfield

  2. Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan

    Wei-Hsin Chung

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  1. Wei-Hsin Chung
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  2. Justin Hayase
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Correspondence to Wei-Hsin Chung.

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The study was approved by the UCLA Institutional Review Board (IRB#11–002516).

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Chung, WH., Hayase, J., Do, D.H. et al. Clinical predictors and implications of cardiac inflammation detected on positron emission tomography (PET) in patients referred for premature ventricular complex (PVC) ablation. J Interv Card Electrophysiol 66, 1253–1263 (2023). https://doi.org/10.1007/s10840-022-01446-z

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  • DOI: https://doi.org/10.1007/s10840-022-01446-z

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