Atrial FDG uptake and atrial fibrillation: A systematic review and meta-analysis
Ahmad Kassar, Nadia Chamoun, Romanos Haykal, Yaacoub Chahine, Miles Babb, Hala Al Yasiri, Tori Hensley, Efstathia Andrikopoulou, Nazem Akoum
Abstract
<h3>Background</h3> Atrial inflammatory and metabolic derangements have been reported in patients with atrial fibrillation (AF). <h3>Objective</h3> We sought to evaluate the association of <sup>18</sup>F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) in the left and right atria and AF. <h3>Methods</h3> We conducted a systematic review and meta-analysis, using the PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of studies involving patients undergoing FDG-PET scans with reported atrial or ventricular uptake and outcomes of AF. Data were pooled and analyzed, and FDG uptake in AF and non-AF patients was compared using odds ratios (ORs). <h3>Results</h3> Six studies (4 retrospective, 1 prospective, and 1 case-control) were included in the meta-analysis of studies on patients not meeting diagnostic criteria for cardiac sarcoidosis (CS): 832 patients with a mean age of 67 years, 62% male, and 53% with hypertension. AF patients demonstrated higher odds of FDG uptake in the left atrium (pooled OR 14.50, 95% confidence interval 6.78–31.02; <i>P</i> < .0001, <i>I</i><sup>2</sup> = 0) and right atrium (pooled OR 51.98, 95% confidence interval 22.77–118.63, <i>P</i> < .0001, <i>I</i><sup>2</sup> = 0). Two studies on patients met diagnostic criteria for CS: one did not report atrial uptake and the other did not demonstrate a statistically significant association between right or left atrial uptake in AF patients. <h3>Conclusion</h3> In patients undergoing FDG-PET without meeting CS diagnostic criteria, FDG uptake in the atria was strongly associated with AF, suggesting altered metabolism or inflammation in AF pathophysiology and risk assessment.