Endomyocardial biopsy-integrating electrode at the bioptome tip.
BACKGROUND
The addition of electroanatomic mapping to a standard echo-guided endomyocardial biopsy could identify areas of abnormal pathology and increase the diagnostic yield of the procedure.


RESULTS
In this demonstration of a novel technique, a 45-year-old woman with clinical suspicion for cardiac sarcoidosis underwent right ventricular bipolar electroanatomical mapping with identification of areas of signal fractionation and low voltage. A bioptome, configured to record an electrogram from the tip, was then visualized on the three-dimensional electroanatomic mapping (3DEAM) system, and directed to these areas. The biopsy was assisted by the use of a steerable introducer sheath, and by recording unipolar and extended bipolar signals from the bioptome tip. A prominent change in the signal was detected by the electrode at the bioptome tip when the jaws closed on the endomyocardial tissue. Patient tolerated the procedure without complications, and the biopsied samples were appropriate for pathological analysis.


CONCLUSIONS
Using existing technology, the 3DEAM, which integrates unipolar and bipolar signal from the bioptome tip, is feasible, and can be safely added to a standard echocardiographically guided endomyocardial biopsy. Future studies should investigate whether such a technique could increase the safety and diagnostic yield of endomyocardial biopsies in patients with suspected cardiomyopathies.
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA and International Clinical Research Center (ICRC) of St. Anne's University Hospital, Brno, Czech Republic.
Tomas
T
Konecny
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA noseworthy.peter@mayo.edu.
Peter A
PA
Noseworthy
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Suraj
S
Kapa
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Leslie T
LT
Cooper
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Siva K
SK
Mulpuru
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Gurpreet S
GS
Sandhu
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine 200 First Street SW, Rochester, MN 55905, USA.
Samuel
S
Asirvatham
D001706:Biopsy / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D009202:Cardiomyopathies / Q000175:diagnosis*; D019560:Echocardiography, Three-Dimensional; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D012507:Sarcoidosis / Q000175:diagnosis*
electroanatomic mapping; endomyocardial biopsy