Abstract 19654: Absence of Cardiovascular Implantable Electronic Device Infection in Remote Implantations Demonstrated by Fluorine-18 Positron Emission Tomography

Abstract

Background: Cardiovascular implantable electronic device (CIED) infection can be very challenging and unnecessary device extraction can expose the patient to significant morbidity and mortality. Recent publications suggests that fluorine-18 (¹⁸F-FDG) positron emission tomography (PET) has a high sensitivity and specificity to differentiate pocket and/or lead infections from non-infected devices older than 6 months. However, control groups were small (n≤10 patients) and the prevalence of increased ¹⁸F-FDG uptake in not-infected CIED patients is unknown.

Method: All patients with remote (>6month) ICD implantation and no clinical/laboratory evidence of infection undergoing 18FDG-PET in preparation for VT ablation from 2006 to 2011 were identified in a single tertiary center. Semi-quantiative ssessment of ¹⁸F-FDG uptake was assessed in 4 sites (generator pocked, innominate vein, superior vena cava (SVC), and intracardiac space (right atrium/ventricle). using a semi-quantitative score assessing .Uptake was categorized in none (score = 0), mild (≤thoracic background activity[t1] ; score = 1), moderate (>thoracic background activity; score = 2), and severe hypermetabolism (very intense uptake; score = 3).

Results: 65 contiguous patients were enrolled in this study. 18FDG PET signal uptake scores were 0 in 0%, 0%, 0%, 0% for generator pocket, innominate vein, SVC and intracardiac position, respectively. Resulting semiquantitative scores were 0.0±0.0 in (locations) and 0.1±0.

Conclusion This as far as we know largest series on 18FDG PET scans in patients with remote device implantation demonstrates no incidence of increased tracer uptake in non-infected patients localized in ¼ This supports a potential use of ¹⁸F-FDG PET/CT in differentiating patients with CIED infection from chronic implant changes, providing a new potentially new path in management of CIED infection.