Prognostic value of fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography in patients with unexplained atrioventricular block

Tamiruddin A Danwade, Soumen Devidutta, Abhijeet B Shelke, Daljeet Kaur Saggu, Sachin D Yalagudri, Chennapragada Sridevi, Nallamala Krishna Reddy, Calambur Narasimhan
Heart Rhythm: the Official Journal of the Heart Rhythm Society 2018, 15 (2): 234-239

BACKGROUND: The cause of atrioventricular conduction block (AVB) remains unexplained in a significant number of patients. Granulomatous myocarditis is an uncommon but important cause of AVB. Fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography (18-FDG PET) scan has emerged as a sensitive tool for diagnosing granulomatous myocarditis.

OBJECTIVE: The purpose of this study was to evaluate the prognostic value of 18-FDG PET scan in patients with unexplained AVB.

METHODS: Patients age 18-55 years presenting with unexplained AVB and requiring a permanent pacemaker were evaluated with a fasting 18-FDG PET scan. Transthoracic echocardiography was performed at baseline and at follow-up. Major adverse cardiac events (ventricular tachycardia, heart failure, cardiac death) were noted during follow-up.

RESULTS: Over a period of 3 years, 35 patients (20 females, 15 males; mean age 43.67 ± 11.21 years) were included in the study. Abnormal myocardial FDG uptake was noted in 15 patients (42.8%). Four patients consented for biopsy of paracardiac FDG avid lymph nodes, which revealed granulomatous inflammation (one of which grew Mycobacterium tuberculosis in culture). Mean follow-up period was 24 months. Major adverse cardiac events were significantly higher in the patients with abnormal PET uptake (P < .01) compared to those with normal scans.

CONCLUSION: Patients with high-degree AVB and abnormal myocardial 18-FDG PET uptake have more adverse cardiac events and worse outcomes. Early screening for myocardial inflammation and appropriate treatment may prevent these complications. Tuberculosis may be an important cause of unexplained AVB, apart from sarcoidosis, in developing countries such as India.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.