Raoult Tristan, Gerber Bernhard L, Garnir Quentin, Scavée Christophe, Varnavas Varnavas, Wauters Aurélien, Gruson Damien, Nellessen Eric, Hesse Michel, Beauloye Christophe, Roelants Véronique, Marchandise Sébastien
Division of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels Belgium.
Pole Molecular Imaging, Radiotherapy & Oncology (MIRO) Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain Brussels Belgium.
J Am Heart Assoc. 2025 Jul 15;14(14):e041491. doi: 10.1161/JAHA.124.041491. Epub 2025 Jul 3.
Left atrial structural remodeling contributes to the persistence of atrial fibrillation (AF) and influences the outcomes of catheter ablation (CA). We investigated the usefulness of F-fluorodeoxyglucose-positron emission tomography in detecting low atrial glucose uptake (LGU) as a potential marker of fibrosis and its predictive value for CA success in persistent AF.
Thirty-six patients without diabetes with persistent AF scheduled for CA underwent nicotinic acid-stimulated F-fluorodeoxyglucose-positron emission tomography to assess global and segmental LGU before CA. LGU was compared with low voltage areas on electroanatomical mapping, left atrial volume index via echocardiography, and late gadolinium enhancement from cardiac magnetic resonance imaging as indicators of fibrosis. Patients were followed for up to 24 months post CA to assess AF recurrence.
Global LGU extent was 16.8% (7.6-42.6) and correlated with left atrial volume index (R=0.20, =0.039) and low voltage area during AF and right atrial pacing (R=0.54 and R=0.35 respectively, both <0.001). Multivariable analysis showed that LGU significantly predicted moderate/severe low voltage area remodeling (<0.001) with an area under the curve of 0.78 (95% CI, 0.58-0.97), independent of clinical and imaging parameters. AF recurred in 50% of patients. LGU >17%, but not late gadolinium enhancement, predicted AF recurrence (=0.026; AUC, 0.67 [95% CI, 0.48-0.86]).
Nicotinic acid-enhanced F-fluorodeoxyglucose-positron emission tomography LGU extent reflects fibrosis by low voltage areas and predicts AF recurrence after CA in patients with persistent AF. This suggests that it could serve as a noninvasive tool for assessing atrial fibrosis and remodeling in atrial cardiomyopathy due to persistent AF.
左心房结构重塑促使心房颤动（AF）持续存在，并影响导管消融（CA）的效果。我们研究了F-氟脱氧葡萄糖正电子发射断层扫描在检测低心房葡萄糖摄取（LGU）方面的作用，LGU作为纤维化的潜在标志物及其对持续性AF患者CA成功的预测价值。
36例计划接受CA的无糖尿病持续性AF患者在CA前接受烟酸刺激的F-氟脱氧葡萄糖正电子发射断层扫描，以评估整体和节段性LGU。将LGU与电解剖标测上的低电压区域、经超声心动图测量的左心房容积指数以及心脏磁共振成像的钆延迟强化作为纤维化指标进行比较。对患者进行CA后长达24个月的随访，以评估AF复发情况。
整体LGU范围为16.8%（7.6 - 42.6），与左心房容积指数（R = 0.20，P = 0.039）以及AF和右心房起搏期间的低电压区域相关（分别为R = 0.54和R = 0.35，均P < 0.001）。多变量分析显示，LGU显著预测中度/重度低电压区域重塑（P < 0.001），曲线下面积为0.78（95%CI，0.58 - 0.97），独立于临床和影像学参数。50%的患者AF复发。LGU>17%可预测AF复发（P = 0.026；AUC，0.67[95%CI，0.48 - 0.86]），但钆延迟强化不能。
烟酸增强的F-氟脱氧葡萄糖正电子发射断层扫描LGU范围通过低电压区域反映纤维化，并预测持续性AF患者CA后的AF复发。这表明它可作为评估持续性AF所致心房心肌病中心房纤维化和重塑的非侵入性工具。
