Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial Fibrillation
Background 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 18F‐fluorodeoxyglucose‐positron emission tomography in detecting low atrial glucose uptake (LGU) as a poten...
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2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.041491 |
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| author | Tristan Raoult Bernhard L. Gerber Quentin Garnir Christophe Scavée Varnavas Varnavas Aurélien Wauters Damien Gruson Eric Nellessen Michel Hesse Christophe Beauloye Véronique Roelants Sébastien Marchandise |
| author_facet | Tristan Raoult Bernhard L. Gerber Quentin Garnir Christophe Scavée Varnavas Varnavas Aurélien Wauters Damien Gruson Eric Nellessen Michel Hesse Christophe Beauloye Véronique Roelants Sébastien Marchandise |
| author_sort | Tristan Raoult |
| collection | DOAJ |
| description | Background 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 18F‐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. Methods Thirty‐six patients without diabetes with persistent AF scheduled for CA underwent nicotinic acid‐stimulated 18F‐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. Results Global LGU extent was 16.8% (7.6–42.6) and correlated with left atrial volume index (R2=0.20, P=0.039) and low voltage area during AF and right atrial pacing (R2=0.54 and R2=0.35 respectively, both P<0.001). Multivariable analysis showed that LGU significantly predicted moderate/severe low voltage area remodeling (P<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 (P=0.026; AUC, 0.67 [95% CI, 0.48–0.86]). Conclusions Nicotinic acid‐enhanced 18F‐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. |
| format | Article |
| id | doaj-art-5d11c11cd44d4d9b9c1a8c249a64c3cd |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-5d11c11cd44d4d9b9c1a8c249a64c3cd2025-08-20T03:13:04ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141410.1161/JAHA.124.041491Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial FibrillationTristan Raoult0Bernhard L. Gerber1Quentin Garnir2Christophe Scavée3Varnavas Varnavas4Aurélien Wauters5Damien Gruson6Eric Nellessen7Michel Hesse8Christophe Beauloye9Véronique Roelants10Sébastien Marchandise11Division of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumPole Molecular Imaging, Radiotherapy & Oncology (MIRO) Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumPole Molecular Imaging, Radiotherapy & Oncology (MIRO) Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain Brussels BelgiumDivision of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD) 10 avenue hippocrate Brussels 1200 Brussels BelgiumBackground 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 18F‐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. Methods Thirty‐six patients without diabetes with persistent AF scheduled for CA underwent nicotinic acid‐stimulated 18F‐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. Results Global LGU extent was 16.8% (7.6–42.6) and correlated with left atrial volume index (R2=0.20, P=0.039) and low voltage area during AF and right atrial pacing (R2=0.54 and R2=0.35 respectively, both P<0.001). Multivariable analysis showed that LGU significantly predicted moderate/severe low voltage area remodeling (P<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 (P=0.026; AUC, 0.67 [95% CI, 0.48–0.86]). Conclusions Nicotinic acid‐enhanced 18F‐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.https://www.ahajournals.org/doi/10.1161/JAHA.124.04149118F‐FDG‐PETatrial cardiomyopathyglucose metabolismleft atrial structural remodelinglow glucose uptake extentpersistent atrial fibrillation |
| spellingShingle | Tristan Raoult Bernhard L. Gerber Quentin Garnir Christophe Scavée Varnavas Varnavas Aurélien Wauters Damien Gruson Eric Nellessen Michel Hesse Christophe Beauloye Véronique Roelants Sébastien Marchandise Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 18F‐FDG‐PET atrial cardiomyopathy glucose metabolism left atrial structural remodeling low glucose uptake extent persistent atrial fibrillation |
| title | Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial Fibrillation |
| title_full | Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial Fibrillation |
| title_fullStr | Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial Fibrillation |
| title_full_unstemmed | Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial Fibrillation |
| title_short | Left Atrial Remodeling Identification and Catheter Ablation Outcomes With 18F‐Fluorodeoxyglucose Positron Emission Tomography in Persistent Atrial Fibrillation |
| title_sort | left atrial remodeling identification and catheter ablation outcomes with 18f fluorodeoxyglucose positron emission tomography in persistent atrial fibrillation |
| topic | 18F‐FDG‐PET atrial cardiomyopathy glucose metabolism left atrial structural remodeling low glucose uptake extent persistent atrial fibrillation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.041491 |
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