Skip to main content
SpringerLink
Log in

The efficacy and safety of electroanatomic mapping-guided endomyocardial biopsy: a systematic review

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Electroanatomic mapping (EAM) has been utilized as a modality to improve the sensitivity of endomyocardial biopsy (EMB). We sought to systematically review published medical literature on the efficacy and safety of EAM-guided EMB.

Methods

We searched Ovid MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central, Scopus, and Web of Science for studies where EAM was used for EMB. Data abstracted included demographics, indications, final diagnoses, histology findings, and technical details of biopsy extraction. Test characteristics including sensitivity (Se), specificity (Sp), and area under curve (AUC) were calculated on a per-patient and per-biopsy level.

Results

Seventeen studies (9 case series, 8 case reports) were included in this systematic review. EAM-guided EMB was performed in 148 patients and results of 207 individual biopsies were available for analysis. The most common indications for EAM-guided EMB were suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), myocarditis, and cardiac sarcoidosis (CS). The pooled sensitivity and specificity for EAM-guided EMB for the diagnosis of cardiomyopathies (ARVC, myocarditis, CS, and other specific diagnoses) were 92 and 58% on per-biopsy analysis and 100 and 39% on per-patient analysis. Among the individual components of abnormal EGMs, abnormal unipolar EGM had the best AUC on per-biopsy (0.81, 95% CI 0.68–0.90) and per-patient analysis (0.84, 95% CI 0.68–0.92). EAM-guided EMB appears safe. Adverse events included 1 hemopericardium, 2 minimal asymptomatic pericardial effusions, and 1 femoral hematoma.

Conclusions

EAM-guided EMB is a safe and efficacious method and might improve test characteristics over conventional fluoroscopy-guided biopsy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J. 2007;28(24):3076–93.

    Article  PubMed  Google Scholar 

  2. Avella A, d'Amati G, Pappalardo A, Re F, Silenzi PF, Laurenzi F, et al. Diagnostic value of endomyocardial biopsy guided by electroanatomic voltage mapping in arrhythmogenic right ventricular cardiomyopathy/dysplasia. J Cardiovasc Electrophysiol. 2008;19(11):1127–34.

    Article  PubMed  Google Scholar 

  3. Pieroni M, Dello Russo A, Marzo F, Pelargonio G, Casella M, Bellocci F, et al. High prevalence of myocarditis mimicking arrhythmogenic right ventricular cardiomyopathy differential diagnosis by electroanatomic mapping-guided endomyocardial biopsy. J Am Coll Cardiol. 2009;53(8):681–9.

    Article  PubMed  Google Scholar 

  4. Ejima K, Shoda M, Manaka T, Hagiwara N. Targeted endomyocardial biopsy using electroanatomical voltage mapping in the early stage of arrhythmogenic right ventricular cardiomyopathy. Europace. 2009;11(3):388–9.

    Article  PubMed  Google Scholar 

  5. Dello Russo A, Pieroni M, Santangeli P, Bartoletti S, Casella M, Pelargonio G, et al. Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: role of cardiac electroanatomical mapping and biopsy. Heart Rhythm. 2011;8(12):1915–22.

    Article  Google Scholar 

  6. Nery PB, Keren A, Healey J, Leug E, Beanlands RS, Birnie DH. Isolated cardiac sarcoidosis: establishing the diagnosis with electroanatomic mapping-guided endomyocardial biopsy. Can J Cardiol. 2013;29(8):1015.e1–3.

    Article  Google Scholar 

  7. Seizer P, Klingel K, Stickel J, Dorn C, Horger M, Kandolf R, et al. Left ventricular site-directed biopsy guided by left ventricular voltage mapping: a proof of principle. Int J Cardiol. 2013;168(3):3113–4.

    Article  PubMed  Google Scholar 

  8. Liang JJ, Hebl VB, DeSimone CV, Madhavan M, Nanda S, Kapa S, et al. Electrogram guidance: a method to increase the precision and diagnostic yield of endomyocardial biopsy for suspected cardiac sarcoidosis and myocarditis. JACC Heart Fail. 2014;2(5):466–73.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Casella M, Pizzamiglio F, Dello Russo A, Carbucicchio C, Al-Mohani G, Russo E, et al. Feasibility of combined unipolar and bipolar voltage maps to improve sensitivity of endomyocardial biopsy. Circ. 2015;8(3):625–32.

    Google Scholar 

  10. Konecny T, Noseworthy PA, Kapa S, Cooper LT, Mulpuru SK, Sandhu GS, et al. Endomyocardial biopsy-integrating electrode at the bioptome tip. Ther Adv Cardiovasc Dis. 2015;9(3):66–9.

    Article  PubMed  Google Scholar 

  11. Pieroni M, Notarstefano P, Camporeale A, Guida R, Grotti S, Rio T, et al. Electroanatomic mapping guide increase diagnostic sensitivity of endomyocardial biopsy in patients with ventricular arrhythmias. Eur Heart J. 2015;36:199–200.

    Article  Google Scholar 

  12. Havranek S, Palecek T, Kovarnik T, Vitkova I, Psenicka M, Linhart A, et al. Arrhythmogenic substrate at the interventricular septum as a target site for radiofrequency catheter ablation of recurrent ventricular tachycardia in left dominant arrhythmogenic cardiomyopathy. BMC Cardiovasc Disord. 2015;15:18.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grotti S, Pieroni M, Notarstefano P, Guida R, Rio T, Camporeale A, et al. Prevalence and significance of electroanatomical and ultrastructural abnormalities in patients with Brugada syndrome. Eur Heart J. 2015;36:1032.

    Google Scholar 

  14. Stoyanov N, Birnie DH, Beanlands RS, Veinot JP, Redpath CJ, Nair GM, et al. Using 3D electroanatomical mapping to guide endomyocardial biopsy for cardiac sarcoidosis. Can J Cardiol. 2014;1:S294.

    Article  Google Scholar 

  15. Serizawa N, Suzuki T, Ejima K, Manaka T, Shiga T, Shoda M, et al. Targeted endomyocardial biopsy using electroanatomical voltage mapping for patients suspected of cardiac sarcoidosis. Eur Heart J. 2014;35:1026.

    Google Scholar 

  16. Seki K, Kobukai Y, Tamura Y, Koyama T, Iino K, Watanabe H, et al. Combination with FDG positron emission tomography/computed tomography (PET/CT) and electroanatomic mapping (CARTO) system are useful for diagnosing isolated cardiac sarcoidosis. J Card Fail. 2014;1:S155–S6.

    Article  Google Scholar 

  17. Narducci ML, Rio T, Perna F, D’Amario D, Merlino B, Marano R, et al. A challenging case of ventricular arrhythmia in a patient with myocarditis: ICD yes/no after ablation. J Atr Fibrillation. 2014;7(3):18–23.

    Google Scholar 

  18. Kawakatsu N, Suzuki A, Serizawa N, Suzuki T, Ejima K, Shiga T, et al. Isolated cardiac sarcoidosis diagnosed by electroanatomic voltage mapping-guided endomyocardial biopsy combined with magnetic resonance imaging and positron emission tomography. J Cardiol Cases. 2016;14(4):107–10.

    Article  Google Scholar 

  19. Dechering DG, Kochhauser S, Zellerhoff S, Frommeyer G, Eckardt L. Three-dimensional electroanatomic voltage mapping to guide biopsy sampling in unexplained cardiomyopathies: a proof-of-principle case series. Clin Res Cardiol. 2016;105(2):186–8.

    Article  PubMed  Google Scholar 

  20. Corrado D, Basso C, Leoni L, Tokajuk B, Bauce B, Frigo G, et al. Three-dimensional electroanatomic voltage mapping increases accuracy of diagnosing arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation. 2005;111(23):3042–50.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Ms. Ann Farrell, MLS, from the Learning Resource Center, Mayo Clinic, Rochester, for her assistance with the systematic review search strategy.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55906, USA

    Vaibhav R. Vaidya, Anas A. Abudan, Krithika Vasudevan, Suraj Kapa, Peter A. Noseworthy, Yong-Mei Cha, Samuel J. Asirvatham & Abhishek J. Deshmukh

  2. Division of Cardiovascular Diseases, University of Iowa, Iowa, IA, USA

    Ghanshyam Shantha

  3. Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA

    Leslie T. Cooper

  4. Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

    Samuel J. Asirvatham

Authors
  1. Vaibhav R. Vaidya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anas A. Abudan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Krithika Vasudevan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ghanshyam Shantha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leslie T. Cooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Suraj Kapa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter A. Noseworthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yong-Mei Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Samuel J. Asirvatham
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Abhishek J. Deshmukh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abhishek J. Deshmukh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Appendix

Appendix

Search strategy

MEDLINE (1946–present)

  1. 1.

    (Endocardium/ or (endocardi* or endomyocardi* or emb).tw) and (exp biopsy/ or biops*.tw)

  2. 2.

    Body Surface Potential Mapping/ or (CARTO or ecvue or enite or navx or rpm or eam*1 or evm*1 or electrogram* or electro-gram* or (real* adj time adj position adj management) or ((electroanatomic* or electro-anatomic* or voltage* or catheter*) adj3 (map or maps or mapping*)).tw

  3. 3.

    1 AND 2

Embase (1988–2017 week 46)

  1. 1.

    (endocardial biopsy/ or endomyocardial biopsy device/) and ((electroanatomic* or electro-anatomic* or voltage* or catheter*) adj3 (map or maps or mapping*)).tw

  2. 2.

    endocardium/ or exp. endocardial disease/ or (endocardi* or endomyocardi* or emb).tw

  3. 3.

    cardiac mapping system/ or mapping catheter/ or ((electroanatomic* or electro-anatomic* or voltage* or catheter*) adj3 (map or maps or mapping*)).tw

  4. 4.

    exp. biopsy technique/ or exp biopsy/ or biops*.tw

  5. 5.

    2 and 3 and 4

  6. 6.

    1 or 5

Web of Science

# 368

#2 AND #1

Indexes=SCI-EXPANDED Timespan=All years

# 223,523

ts=(CARTO or ecvue or enite or navx or rpm or eam*1 or evm*1 or electrogram* or electro-gram* or (real* NEAR/1 time NEAR/1 position NEAR/1 management) or ((electroanatomic* or electro-anatomic* or voltage* or catheter*) NEAR/3 (map or maps or mapping*)))

Indexes=SCI-EXPANDED Timespan=All years

# 14531

ts=((endocardi* or endomyocardi* or emb) NEAR/3 biops*)

Indexes=SCI-EXPANDED Timespan=All years

Scopus

(TITLE-ABS-KEY ((endocardi* OR endomyocardi* OR emb ) W/3 biops*)) AND (TITLE-ABS-KEY (carto OR ecvue OR enite OR navx OR rpm OR eam*1 OR evm*1 OR electrogram* OR electro-gram* OR (real* W/1 time W/1 position W/1 management) OR ((electroanatomic* OR electro-anatomic* OR voltage* OR catheter*) W/3 (map OR maps OR mapping*))))

Cochrane Central (October 2017) and Cochrane Database of Systematic Reviews (2005–October 2017)

  1. 1.

    ((endocardi* or endomyocardi* or emb) adj3 biops*).mp

  2. 2.

    (CARTO or ecvue or enite or navx or rpm or eam*1 or evm*1 or electrogram* or electro-gram* or (real* adj time adj position adj management) or ((electroanatomic* or electro-anatomic* or voltage* or catheter*) adj3 (map or maps or mapping*))).mp

  3. 3.

    1 AND 2

Database

References

References after de-duplication

MEDLINE

73

65

Embase

88

52

Web of Science

79

29

Scopus

76

16

Cochrane

3

1

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vaidya, V.R., Abudan, A.A., Vasudevan, K. et al. The efficacy and safety of electroanatomic mapping-guided endomyocardial biopsy: a systematic review. J Interv Card Electrophysiol 53, 63–71 (2018). https://doi.org/10.1007/s10840-018-0410-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-018-0410-7

Keywords

Search

Navigation