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Updated: Jul 9, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Right atrial wall inflammation detected by 18F-FDG PET/CT may be significantly associated with persistent atrial
Peng Wan1, Bing Wang2,3, Wenji Yu2,3
1Department of Cardiology, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, Jiangsu Province, 213003, China.
Aim:
Atrial fibrillation (AF) is a progressive disease from paroxysmal to persistent, and persistent AF (PerAF) had worse prognosis. AF has potential link with inflammation, but it is not clear whether PerAF or paroxysmal AF (ParAF) is more closely related to inflammation. On the basis of inhibiting myocardial physiological uptake, 18F-fluorodeoxyglucosepositron emission tomography/computed tomography (18F-FDG PET/CT) is an established imaging modality to detect cardiac inflammation. We aimed to decipher the association between AF and atrial inflammatory activity by 18F-FDG PET/CT.
Methods:
Thirty-five PerAF patients were compared to age and sex matched ParAF group with baseline 18F-FDG PET/CT scans prior to radiofrequency catheter ablation (RFCA) in the prospective case-control study. High-fat and low-carbohydrate diet and prolonged fast (HFLC+Fast) was applied to all AF patients before PET/CT. Then 22 AF patients with positive right atrial (RA) wall FDG uptake (HFLC+Fast) were randomly selected and underwent HFLC+Fast+heparin the next day. The CHA2DS2-VASc score was calculated to evaluate the risk of stroke. Clinical data, ECG, echocardiography, and atrial 18F-FDG uptake were compared.
Results:
PerAF patients had significantly higher probability of RA wall positive FDG uptake and higher SUVmax than ParAF group [91.4% VS. 28.6%, P < 0.001; SUVmax: 4.10(3.20-4.90) VS. 2.60(2.40-3.10), P < 0.001]. Multivariate logistic regression analyses demonstrated that RA wall SUVmax was the independent influencing factor of PerAF (OR = 1.80, 95%CI 1.02-3.18, P = 0.04). In 22 AF patients with RA wall positive FDG uptake (HFLC+Fast), the "HFLC+Fast+Heparin" method did not significantly change RA wall FDG uptake evaluated by either quantitative analysis or visual analysis. High CHA2DS2-VASc score group had higher RA wall 18F-FDG uptake [3.35 (2.70, 4.50) vs, 2.8 (2.4, 3.1) P = 0.01].
Conclusions:
RA wall FDG positive uptake was present mainly in PerAF. A higher RA wall 18F-FDG uptake was an independent influencing factor of PerAF. RA wall FDG uptake based on 18F-FDG PET/CT may indicate pathological inflammation.
Trial Registration:
http://www.chictr.org.cn , ChiCTR2000038288.
Insights
Persistent atrial fibrillation (PerAF) shows significantly higher cardiac inflammation than paroxysmal AF (ParAF). 18F-FDG PET/CT imaging reveals that right atrial wall inflammation is an independent predictor of PerAF, suggesting its role in disease progression.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Atrial fibrillation (AF) progresses from paroxysmal to persistent forms, with persistent AF (PerAF) associated with a worse prognosis.
- The link between AF and inflammation is recognized, but the differential association of inflammation with paroxysmal AF (ParAF) versus PerAF remains unclear.
- 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a valuable tool for detecting cardiac inflammation by inhibiting physiological myocardial uptake.
Purpose of the Study:
- To investigate the association between AF progression and atrial inflammatory activity using 18F-FDG PET/CT.
- To compare the degree of atrial inflammation in patients with PerAF versus ParAF.
- To determine if atrial inflammation is an independent predictor of PerAF.
Main Methods:
- A prospective case-control study compared 35 PerAF patients with age- and sex-matched ParAF patients using baseline 18F-FDG PET/CT scans before radiofrequency catheter ablation (RFCA).
- Patients underwent a high-fat, low-carbohydrate diet with prolonged fasting (HFLC+Fast) before PET/CT.
- Right atrial (RA) wall 18F-FDG uptake was assessed, and the CHA2DS2-VASc score was calculated.
Main Results:
- PerAF patients exhibited a significantly higher prevalence of positive RA wall FDG uptake (91.4% vs. 28.6%, P < 0.001) and higher SUVmax (4.10 vs. 2.60, P < 0.001) compared to ParAF patients.
- Multivariate logistic regression identified RA wall SUVmax as an independent influencing factor for PerAF (OR = 1.80, P = 0.04).
- Higher CHA2DS2-VASc scores correlated with increased RA wall 18F-FDG uptake (P = 0.01).
Conclusions:
- Right atrial wall FDG-positive uptake is predominantly observed in PerAF.
- Elevated RA wall 18F-FDG uptake is an independent predictor of PerAF.
- 18F-FDG PET/CT assessment of RA wall FDG uptake may serve as an indicator of pathological atrial inflammation in AF.
