IMAGES THAT TEACH Can PET/CT be useful in predicting ventricular arrhythmias in Chagas Disease? Renata Junqueira Moll-Bernardes, MD, PhD, a Rene ´e Sarmento de Oliveira, MD, a Adriana Soares Xavier de Brito, MD, a Sergio Altino de Almeida, MD, a Paulo Henrique Rosado-de-Castro, MD, PhD, a and Andre ´a Silvestre de Sousa, MD, PhD a,b a D’Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, Rio de Janeiro, RJ, Brazil b Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil Received Dec 13, 2019; accepted Dec 13, 2019 doi:10.1007/s12350-019-02014-1 Ventricular arrhythmias are a major cause of mor- bidity and mortality in patients with Chagas disease and may occur even before significant left ventricular (LV) systolic dysfunction. Cardiac Chagas disease is charac- terized by chronic persistent myocardial inflammation, which plays a central role in the genesis of arrhythmias due to irreversible cell damage and scar formation. In addition, active inflammation may increase the auto- maticity within inflamed areas, or act as a trigger for re- entry in the presence of fibrosis. CASE SUMMARY A 68-year-old man presented with an episode of sustained ventricular tachycardia associated to cardiac Chagas disease with ischemic changes on ECG, moderate LV dysfunction and an apical aneurysm on echocardio- graphy. Cardiac magnetic resonance (CMR) imaging showed apical aneurysm and inferolateral late gadolin- ium enhancement (LGE). Fluorine-18-labeled 2-deoxy- 2-fluoro-D-glucose ( 18 F-FDG) positron emission tomog- raphy (PET)/computed tomography (CT) and 68-labeled gallium-DOTA-tyr3-Octreotide ( 68 Ga-DOTATOC) PET/CT revealed increased uptake adjacent to hypoper- fused or fibrotic areas (Figures 1, 2, 3, 4). DISCUSSION Molecular imaging, with a variety of radiotracers, offers a valuable tool to identify the various phys- iopathological changes that predispose to arrhythmia such as hypoperfusion, presence of inflammation, and abnormal sympathetic innervation. Two previous case reports have described increased uptake of 18 F-FDG PET in patients with Chagas disease and ventricular tachycardia, suggesting that the presence of inflamma- tion could be involved in the genesis of the arrhythmia. 1,2 Recently, the use of new radiotracers that are not physiologically accumulated in the normal myocardium such as 68 Ga-DOTATOC may overcome some limitations of the 18 F-FDG, as has been reported for cardiac sarcoidosis. 3 To our knowledge, there are no previous report of increased 68 Ga-DOTATOC uptake in patients with ventricular arrhythmia due to Chagas disease. Better understanding of the role of inflammation in these patients may provide novel treatment strategies such as localization of anatomic substrate before abla- tion of VT and improved risk stratification and orientation about primary prevention with ICD implantation. Disclosures Renata Junqueira Moll-Bernardes, Rene ´e Sarmento de Oliveira, Adriana Soares Xavier de Brito, Sergio Altino de Almeida MD, Paulo Henrique Rosado-de-Castro MD, and Funding This work was supported by D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, Oswaldo Cruz Foundation, INOVA (VPPCB-007-FIO-18-2-10-30) Rio de Janeiro, Brazil and the Brazilian National Council for Scientific and Tech- nological Development (437025/2018-7). Reprint requests: Renata Junqueira Moll-Bernardes, MD, PhD, D’Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ 22281-100, Brazil; renata.moll@idor.org J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.