Minji Kim BA, Benjamin Lee BA, Justin Hayase MD, Duc H Do MD MPH, Jason Bradfield MD
Use Of PET-CT Imaging To Guide Treatment Of Ventricular Tachycardia
Background: Cardiac inflammation plays a significant role in the development of ventricular tachycardia (VT); however, the optimal treatment strategies remain unknown. PET-CT imaging can reveal underlying inflammation and select patients who may benefit from immunosuppression.
Objective: Determine the utility of PET-CT in guiding management decisions for ventricular tachycardia.
Methods: We retrospectively reviewed all patients who underwent PET-CT for VT at UCLA between 2012-2019. Clinical characteristics including PET-CT results, treatment, and outcomes were collected. Patients with pre-existing autoimmune disease or taking immunosuppressive medication prior to evaluation were excluded.
Results: PET-CT was performed in 137 patients (median age 58 years, 79.6% male, mean LVEF 45%) for VT. A cardiac inflammatory process was found in 33 scans, while 104 were negative or inconclusive. Patients were followed for a median of 27.6 months (IQR: 3.3, 54.9). Of the patients with positive PET scans, 21 were initially treated with immunosuppression (3 developed recurrent VT requiring a subsequent ablation), 6 were treated with concurrent ablation and immunosuppression, 1 was treated with ablation alone (patient ended up receiving a heart transplant), and 5 were managed with antiarrhythmic medications. There was no significant difference in recurrence between PET-positive and PET-negative groups (39.3% vs 32.4%; p = 0.50) or time to recurrence (p = 0.89). Of the PET-positive patients receiving immunosuppression, 8/21 (38.1%) had recurrence. Of the PET-negative patients who underwent ablation, 22/54 (40.7%) had recurrence. There was no significant difference in outcomes comparing PET-positive immunosuppression only versus PET-negative ablation patients (p=0.83).
Conclusion: PET-CT can identify patients with a cardiac inflammatory process who may benefit from immunosuppression. In patients with PET-positive imaging, treatment with immunosuppression yielded similar results as in patients without inflammation who underwent ablation in this series. The incorporation of PET-CT imaging into the evaluation for ventricular arrhythmias can potentially obviate the need for invasive procedures.