Positron emission tomography in patients with suspected pacing system infections may play a critical role in difficult cases

• Published in: Heart rhythm Vol. 8; no. 9; pp. 1478 - 1481
• Main Authors: Ploux, Sylvain, MD, Riviere, Annalisa, MD, Amraoui, Sana, MD, Whinnett, Zachary, MD, PhD, Barandon, Laurent, MD, PhD, Lafitte, Stephane, MD, PhD, Ritter, Philippe, MD, Papaioannou, Georgios, MD, Clementy, Jacques, MD, Jais, Pierre, MD, Bordenave, Laurence, MD, Haissaguerre, Michel, MD, Bordachar, Pierre, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2011
• Subjects: Aged; Arrhythmias, Cardiac - therapy; Bacterial Infections - diagnosis; Bacterial Infections - diagnostic imaging; Bacterial Infections - etiology; Cardiovascular; Case-Control Studies; Endocarditis; Female; Fever of Unknown Origin - diagnosis; Fluorodeoxyglucose F18; Humans; Male; Pacemaker Infection; Pacemaker, Artificial - adverse effects; Positron emission tomographic scan; Positron-Emission Tomography - methods; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Surgical Wound Infection - diagnosis; Surgical Wound Infection - diagnostic imaging; Surgical Wound Infection - etiology; Tomography, X-Ray Computed - methods; FDG-PET/CT; Positron emission tomographic scan; Endocarditis; FDG; 18F-fluorodeoxyglucose; Pacemaker Infection; 18F-fluorodeoxyglucose positron emission tomography/computerized tomography
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2011.03.062

Background A pacemaker recipient may be hospitalized recurrently with an infection of unknown origin despite detailed investigations. Objective The purpose of this study was to investigate whether18 F-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG-PET/CT) scanning has a role in identifying pacing material infection in these difficult cases. Methods Ten patients who presented with fever of unknown origin despite detailed investigations including transesophageal echocardiography underwent FDG-PET/CT scanning. Identification of increased FDG uptake along a pacing lead prompted the removal of the entire pacing system, whereas in the absence of increased FDG uptake the pacing material was left in place. Forty control pacemaker recipients underwent FDG-PET/CT scanning as part of investigation of malignancy. Results Among the 40 patients in the control group, FDG-PET/CT scanning was normal in 37 (92.5%) patients. Among the 10 patients who presented with suspected pacing system infections, FDG-PET/CT scanning showed increased FDG uptake along a lead in six patients; as a result of this finding, these patients subsequently underwent complete removal of the implanted material. Cultures of the leads were positive in all six patients, confirming involvement of the leads in the infectious process. In the other four patients, the pacing system was left in place without objective signs of active lead endocarditis during follow-up. Conclusion This study demonstrates the potential value of FDG-PET/CT scanning in the diagnosis of pacing lead endocarditis in difficult cases. Increased FDG uptake along a lead in this clinical context appears to be a reliable sign of active infection.