Safety of endomyocardial biopsy in patients with arrhythmogenic right ventricular cardiomyopathy: a study analyzing 161 diagnostic procedures.
OBJECTIVE
The aim of the present study was to assess the feasibility and safety of target-directed sampling of right ventricular (RV) endomyocardial biopsies (EMB) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).


BACKGROUND
EMB is an integral part of the diagnostic evaluation of ARVC. Due to safety concerns, EMB are often obtained from the RV septum, which is usually spared from characteristic alterations. At our institution, EMB in ARVC patients were sampled target-directed from predilection areas and areas with abnormal contraction.


METHODS
Under fluoroscopic guidance, 3,777 EMB samples from 6 different RV sites were obtained in 482 patients who were evaluated for unclear cardiomyopathy (n = 280; 58%), assumed myocarditis (n = 59; 12%), or unexplained ventricular tachyarrhythmias (n = 143; 30%). Complication rates were compared with those from exclusively septal EMB procedures (n = 2,321) in 271 patients after heart transplantation (HTx).


RESULTS
Overall, no procedure-related deaths or sustained ventricular tachyarrhythmias occurred. A pericardial effusion was reported in 6 of 161 patients with the final diagnosis of ARVC (3.7%) needing no further intervention in all but 1 patient (0.6%) who required pericardiocentesis. Among the non-ARVC patients (n = 321), the incidence of a minor pericardial effusion (3.9%) and cardiac tamponade (2.2%) was comparable to that in ARVC (p = NS) but was higher when compared with HTx (p < 0.001). A transient complete atrioventricular block occurred in 1 of 321 non-ARVC (0.3%) and 2 of 271 HTx patients (0.1%).


CONCLUSIONS
Multisite target-directed EMB sampling in ARVC is a safe procedure when performed by experienced interventionalists. The procedure-related complication rates were low and comparable to those in other cardiomyopathies.
Department of Cardiology and Angiology, University Hospital of Münster, Münster, Germany. matthias.paul@ukmuenster.de
Matthias
M
Paul
Jörg
J
Stypmann
Joachim
J
Gerss
Sophia
S
Wirdeier
Sven
S
Zumhagen
Günter
G
Breithardt
Eric
E
Schulze-Bahr
Thomas
T
Wichter
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000473:pathology; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D002305:Cardiac Tamponade / Q000209:etiology; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D010996:Pleural Effusion / Q000209:etiology; D012307:Risk Factors