Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Electrocardiography D-PO02 - Poster Session II (ID 47) Poster

D-PO02-205 - Biatrial FDG Uptake Is Associated With Partial Interatrial Block And Is A Predictor Of Atrial Fibrillation In Cardiac Sarcoidosis (ID 254)

Disclosure
 M. Nellaiyappan: Nothing relevant to disclose.

Abstract

Background: 18-F-Fluorodeoxy glucose (FDG) uptake in the ventricular myocardium by PET imaging and associated atrioventricular conduction abnormalities or ventricular tachycardia are hallmarks of cardiac sarcoidosis. Focal uptake of FDG in the atrium has been recently described in cardiac sarcoidosis. However, its association with atrial conduction abnormalities and atrial arrhythmias has not been well described.
Objective: The purpose of this retrospective cohort study was to correlate atrial conduction abnormalities and atrial arrhythmias on 12 lead ECG with atrial FDG uptake in cardiac sarcoidosis patients.
Methods: Fifty one consecutive patients with definitive or probable cardiac sarcoidosis who underwent 18-F-FDG PET in our institution from 1/2016 to 1/2019 were enrolled in the study. Patient demographics, atrial ECG abnormalities, PET data, and presence of atrial arrhythmias were analyzed.
Results: Focal FDG uptake in the atria was noted in 6 patients (11.7%), all of whom were male with a median age of 45 years (range 35-81). Biatrial uptake was noted in 4 patients (7.8%); right atrial uptake only was noted in 2 patients (3.9%). Partial interatrial block (P-IAB), defined as P wave prolongation >120 ms and a bifid P wave morphology in leads I,II,III or aVL, was noted in 3 patients (5.8%), all of whom had biatrial FDG uptake (P=0.0017, Odds ratio 221). Atrial fibrillation (AF) or atrial flutter was noted in 8 patients (15.6%). In patients with biatrial FDG uptake, the prevalence of AF was 100% (4/4) while it was 8.8% (4/47) in patients without biatrial FDG uptake (P=0.0045, Odds ratio 87). One patient with biatrial FDG uptake was in persistent AF in all available ECGs and could not be assessed for P-IAB. Patients with FDG uptake only in the right atrium had neither AF nor P-IAB; however, one of the two patients developed sinus node dysfunction requiring permanent atrial pacing.
Conclusion: Biatrial FDG uptake is associated with P-IAB and AF in cardiac sarcoidosis. The location of atrial FDG uptake may correlate with the type of atrial conduction abnormality - sinus node dysfunction in right atrial FDG uptake and P-IAB in biatrial FDG uptake. Further studies with larger sample size are warranted to confirm these findings.
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