Department of Cardiac Center, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China.
Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing 100020, China.
Eur Heart J Cardiovasc Imaging. 2021 Dec 18;23(1):102-112. doi: 10.1093/ehjci/jeab088.
This prospective study explored relevant factors and clinical significance of atrial 18F-fluorodeoxyglucose (FDG) uptake in patients with atrial fibrillation (AF).
One hundred AF patients underwent baseline FDG imaging prior to radiofrequency catheter ablation (RFCA). Of those, 30 subjects underwent additional FDG imaging at 3 months post-RFCA. Voltage mapping of the left atrium was analysed as a voltage score. Patients who received RFCA were followed for 26 months (17-31 months) to assess recurrence. At baseline FDG imaging, 74% of patients with persistent AF (PsAF) and 24% of patients with paroxysmal AF showed increased atrial FDG uptake. The prevalence was higher in the right atrium (49%) than in the left atrium (15%, P < 0.001) or left atrial appendage (21%, P < 0.001). Multivariate analysis demonstrated that PsAF and elevated B-type natriuretic peptide (BNP) were related to enhanced right atrial (RA) activity, and increased epicardial adipose tissue (EAT) activity was predictive of left atrial (LA) activity. LA activity was inversely associated with voltage score, while increased FDG uptake in the right atrium was predictive of successful AF termination by RFCA. Atrial FDG activities decreased significantly post-RFCA, but none of the FDG parameters were predictive of AF recurrence.
Enhanced RA activity was associated with elevated BNP level, whereas LA activity was related to the increased activity of EAT and inversely correlated with LA fibrosis. Increased RA activity was predictive of successful AF termination by RFCA in PsAF patients.
本前瞻性研究旨在探讨心房颤动（AF）患者心房 18F-氟脱氧葡萄糖（FDG）摄取的相关因素及其临床意义。
100 例 AF 患者在射频导管消融（RFCA）前进行基线 FDG 成像。其中，30 例患者在 RFCA 后 3 个月进行了额外的 FDG 成像。左心房的电压图分析作为电压评分。接受 RFCA 的患者随访 26 个月（17-31 个月）以评估复发。在基线 FDG 成像时，74%的持续性 AF（PsAF）患者和 24%的阵发性 AF 患者显示心房 FDG 摄取增加。右心房（49%）的发生率高于左心房（15%，P<0.001）或左心耳（21%，P<0.001）。多变量分析表明，PsAF 和升高的 B 型利钠肽（BNP）与增强的右心房（RA）活性相关，而增加的心外膜脂肪组织（EAT）活性预测左心房（LA）活性。LA 活性与电压评分呈负相关，而右心房 FDG 摄取增加可预测 RFCA 成功终止 AF。RFCA 后心房 FDG 活性显著降低，但无任何 FDG 参数可预测 AF 复发。
增强的 RA 活性与升高的 BNP 水平相关，而 LA 活性与 EAT 活性增加有关，与 LA 纤维化呈负相关。PsAF 患者的 RA 活性增加可预测 RFCA 成功终止 AF。
