Metabolic heterogeneous zone assessed by 18FDG-PET is predictive of postablation mortality in patients with ventricular tachycardia

Brian Miller, Rama Vunnam, Olurotimi Mesubi, Mark F. Smith, Wengen Chen, Jagat Bandhu Mahat, Soren M. Bentzen, Vincent See, Alejandro Restrepo, Stephen Shorofsky, Vasken Dilsizian, Timm Michael L. Dickfeld

Research output: Contribution to journalArticlepeer-review


Purpose: We sought to study the predictive value of the metabolic heterogeneous zone (HZ) as determined by 18Fluorodeoxyglucose (18FDG) positron emission tomography (PET) viability studies in ventricular tachycardia (VT) patients. Methods: PET studies utilizing 82Rubidium (82Rb) tracer for perfusion and 18FDG tracer for viability were analyzed using PMOD (PMOD Technologies) and further analyzed using 684-segment plots. 18FDG uptake was normalized to the area with maximal perfusion on the rest 82Rb study. Metabolic scar, HZ, and healthy segments were defined with perfusion-normalized 18FDG uptake between 0%–50%, 50%–70%, and >70%, respectively. Results: Thirty-four VT patients (age, 63 ± 12 years) were evaluated with 18FDG-PET viability study. Most (n = 31) patients underwent VT ablation. Patients were categorized to HZ < median versus HZ ≥ median based on a median HZ area size of 21.0 cm2. HZ size was significantly larger in the deceased group than the alive group (35.2 cm2 vs. 18.1 cm2, p =.01). Deaths were significantly higher in HZ ≥ 21 cm2 group than HZ < 21 cm2 group (58.8% vs. 11.8%, p =.005). Survival analysis showed significantly higher mortality in the HZ ≥ 21 cm2 group than the HZ < 21 cm2 group (HR = 4.1, 95% CI: 1.3–12.6, p =.016). In a multivariable analysis, HZ was found to be an independent predictor for all-cause mortality (HR = 1.07, 95% CI: 1.02–1.12, p =.01). Conclusions: Increased HZ size of myocardium was associated with increased mortality. Metabolic HZ quantification may be of value in risk stratification and management of ischemic and nonischemic patients with VT.

Original languageEnglish (US)
Pages (from-to)2238-2245
Number of pages8
JournalJournal of cardiovascular electrophysiology
Issue number8
StatePublished - Aug 2021
Externally publishedYes


  • ablation
  • heterogeneous zone
  • mortality
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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