Emergence of ¹⁸F-FDG positron emission tomography in the detection and characterization of cardiac implantable device infections

Excerpt

There is rapid increase of patients with cardiac implantable electronic devices (CIED) such as such as pacemakers, defibrillators, prosthetic valves, and left ventricular assist devices that improves quality of life and longevity in these individuals.1,2 The downside, however, is an increasing rate of CIED infections accounting for a relative increase in morbidity and also mortality.2,3 The identification and characterization of CIED infections may pose a challenge due to atypical clinical manifestation and frequent inconclusive findings on echocardiography.4 Clinical diagnosis of CIED infection relies on systemic signs of inflammation, local signs of infection of the CIED pocket-lead (edema, erythema, skin erosion, purulent fluid, etc.), bacterial cultures of blood and extracted devices, and detection of vegetation’s on lead tips on echocardiography. The commonly used clinical Duke-Li classification, however, yields a low sensitivity for the detection of CIED infections. In addition, the Duke-Li criteria may not be suitable to identify early infection of CIED for a timely and effective intervention.5,6 Of course, when there are unequivocal clinical signs of pocket infection, and/or vegetation’s with systemic symptoms, then the diagnosis is definitive and extraction of the CIED commonly ensues. Conversely, in case of equivocal clinical and echocardiographic findings in patients with suspicion for CIED infection, there is an emerging and promising role of ¹⁸F-fluorodeoxyglucose (FDG)-PET imaging despite limited data available.7,8 …