The Role of Cardiac Positron Emission Tomography in Prediction of Atrial Fibrillation Rhythm: A Systematic Review and Meta-Analysis Publisher Pubmed



Shojaei S ; Mousavi A ; Zooravar D ; Radkhah H ; Soltani P
Source: Heart and Lung Published:2026

Abstract

Background: Atrial fibrillation (AF), the most common cardiac arrhythmia, is driven by inflammation-induced fibrosis and remodeling. Positron emission tomography (PET) offers a promising alternative by visualizing metabolic and inflammatory activity in cardiac tissue. Objectives: Evaluate PET's role in predicting AF to improve risk stratification and patient outcomes. Methods: Systematic review of PubMed, Scopus, Web of Science, EMBASE was conducted using PRISMA guidelines. Our meta-analysis was registered in PROSPERO (CRD42024602021). Studies comparing quantitative PET scan parameters in AF versus non-AF patients were included. Random-effects models were performed using standardized mean differences (SMD) with 95 % Confidence intervals (CIs). Sensitivity analyses and publication bias with Egger's test and meta-regression analyses were performed. Results: Ten studies with 1145 participants (661 with AF, 484 controls) were included. Patients with AF demonstrated significantly higher maximum SUV in the left atrium (LA) (SMD: 0.62, 95 % CI 0.41–0.83), left atrial appendage (LAA) (SMD: 0.78, 95 % CI 0.41–1.15), right atrium (RA) (SMD: 1.00, 95 % CI 0.72–1.27), and right atrial appendage (RAA) (SMD: 0.89, 95 % CI 0.63–1.14), but no significant differences in mean SUV or left ventricle (LV) metrics. Target-to-background ratios (TBR) were also significantly elevated in the LA, LAA, RA, and RAA in AF patients (p < 0.01). Conclusion: Inflammation and AF suggest a bidirectional relationship as supported by cardiac FDG-PET imaging. Early detection using PET scans can enhance AF management by preventing irreversible cardiac damage. © 2025 Elsevier B.V., All rights reserved.