Electroanatomical mapping systems and intracardiac echo integration for guided endomyocardial biopsy

Area of Science:

• Cardiology
• Electrophysiology
• Pathology

Background:

• Endomyocardial biopsy (EMB) is increasingly used but its role in diagnosing cardiovascular diseases, particularly unexplained ventricular arrhythmias, remains debated.
• Traditional EMB relies on fluoroscopy, which has limitations in accuracy and safety.

Purpose of the Study:

• To review the methodology of EMB guided by advanced imaging techniques.
• To compare integrated EMB with traditional fluoroscopy-guided methods.
• To highlight the role of electrophysiologists in performing EMB for arrhythmias.

Main Methods:

• Description of EMB guided by 3D electroanatomical mapping systems and intracardiac echo.
• Summary of the classical fluoroscopy-guided EMB technique.
• Presentation of the 'electrophysiologist-made' integrated EMB methodology.

Main Results:

• The integrated EMB methodology significantly improved biopsy diagnostic yield.
• This advanced approach led to a reduction in biopsy-related complications.
• Electrophysiologists performing EMB has become more common for specific conditions.

Conclusions:

• EMB guided by electroanatomical mapping and intracardiac echo offers a superior diagnostic approach for ventricular arrhythmias.
• This technique is particularly valuable in diagnosing conditions like arrhythmogenic cardiomyopathy, myocarditis, and cardiac sarcoidosis.
• The 'electrophysiologist-made' EMB enhances diagnostic accuracy and patient safety in managing complex cardiovascular conditions.