Michela Casella1, Francesca Pizzamiglio2, Antonio Dello Russo2, Corrado Carbucicchio2, Ghaliah Al-Mohani2, Eleonora Russo2, Pasquale Notarstefano2, Maurizio Pieroni2, Giulia D'Amati2, Elena Sommariva2, Marta Giovannardi2, Andrea Carnevali2, Stefania Riva2, Gaetano Fassini2, Fabrizio Tundo2, Pasquale Santangeli2, Luigi Di Biase2, Leonardo Bolognese2, Andrea Natale2, Claudio Tondo1. 1. From the Cardiac Arrhythmia Research Centre, Milan, Italy (M.C., F.P., A.D.R., C.C., G.A.-M., E.R., S.R., G.F., F.T., C.T.); Centro Cardiologico Monzino IRCCS, Milan, Italy (E.S., M.G.); Cardiovascular and Neurological Department, San Donato Hospital, Arezzo, Italy (P.N., M.P., A.C., L.B.); Department of Experimental Medicine, Sapienza University, Rome, Italy (G.D.A.,); Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin (P.S., L.D.B., A.N.); Department of Cardiology, University of Foggia, Foggia, Italy (P.S., L.D.B.); Albert Einstein College of Medicine at Montefiore Hospital, New York City (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Division of Cardiology, Stanford University, Palo Alto, CA (A.N.); Case Western Reserve University, Cleveland, OH (A.N.); Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and EP Services, California Pacific Medical Center, San Francisco (A.N.). michela.casella@ccfm.it claudio.tondo@ccfm.it. 2. From the Cardiac Arrhythmia Research Centre, Milan, Italy (M.C., F.P., A.D.R., C.C., G.A.-M., E.R., S.R., G.F., F.T., C.T.); Centro Cardiologico Monzino IRCCS, Milan, Italy (E.S., M.G.); Cardiovascular and Neurological Department, San Donato Hospital, Arezzo, Italy (P.N., M.P., A.C., L.B.); Department of Experimental Medicine, Sapienza University, Rome, Italy (G.D.A.,); Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin (P.S., L.D.B., A.N.); Department of Cardiology, University of Foggia, Foggia, Italy (P.S., L.D.B.); Albert Einstein College of Medicine at Montefiore Hospital, New York City (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Division of Cardiology, Stanford University, Palo Alto, CA (A.N.); Case Western Reserve University, Cleveland, OH (A.N.); Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and EP Services, California Pacific Medical Center, San Francisco (A.N.).
Abstract
BACKGROUND: Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases. METHODS AND RESULTS: We performed endocardial bipolar EVM-guided EMBs in 29 patients and we analyzed unipolar EVM at withdrawal sites. Eighty myocardial samples were collected (mean, 2.8±0.9; median, 3 fragments per patient) and 60 were suitable for histological analysis. Ten specimens (17%) were collected from an area with discordant normal bipolar/low-voltage unipolar EVM and they were diagnostic or suggestive for arrhythmogenic right ventricular dysplasia/cardiomyopathy in 6 patients, for myocarditis and sarcoidosis in 1 patient each. Six samples (10%) were collected from an area with discordant low-voltage bipolar/normal unipolar EVM and they showed nonspecific features. The sensitivity of unipolar EVMs for a diagnostic biopsy finding EMB was significantly higher compared with bipolar EVMs analyzed according to samples (P<0.01) and patients (P=0.008). The specificity of unipolar EMB was better than bipolar EMB when analyzed for all samples (P=0.0014) but the difference did not reach statistical significance when analyzed by patient (P=0.083). The diagnostic yield was 63.3% for the bipolar and 83.3% for the unipolar EVM. CONCLUSIONS: These findings suggest that use of a combined bipolar/unipolar map may be able to improve the diagnostic yield of endomyocardial ventricular biopsy.
BACKGROUND: Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases. METHODS AND RESULTS: We performed endocardial bipolar EVM-guided EMBs in 29 patients and we analyzed unipolar EVM at withdrawal sites. Eighty myocardial samples were collected (mean, 2.8±0.9; median, 3 fragments per patient) and 60 were suitable for histological analysis. Ten specimens (17%) were collected from an area with discordant normal bipolar/low-voltage unipolar EVM and they were diagnostic or suggestive for arrhythmogenic right ventricular dysplasia/cardiomyopathy in 6 patients, for myocarditis and sarcoidosis in 1 patient each. Six samples (10%) were collected from an area with discordant low-voltage bipolar/normal unipolar EVM and they showed nonspecific features. The sensitivity of unipolar EVMs for a diagnostic biopsy finding EMB was significantly higher compared with bipolar EVMs analyzed according to samples (P<0.01) and patients (P=0.008). The specificity of unipolar EMB was better than bipolar EMB when analyzed for all samples (P=0.0014) but the difference did not reach statistical significance when analyzed by patient (P=0.083). The diagnostic yield was 63.3% for the bipolar and 83.3% for the unipolar EVM. CONCLUSIONS: These findings suggest that use of a combined bipolar/unipolar map may be able to improve the diagnostic yield of endomyocardial ventricular biopsy.
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Panithaya Chareonthaitawee; Rob S Beanlands; Wengen Chen; Sharmila Dorbala; Edward J Miller; Venkatesh L Murthy; David H Birnie; Edward S Chen; Leslie T Cooper; Roderick H Tung; Eric S White; Salvador Borges-Neto; Marcelo F Di Carli; Robert J Gropler; Terrence D Ruddy; Thomas H Schindler; Ron Blankstein Journal: J Nucl Cardiol Date: 2017-10 Impact factor: 5.952
Authors: Panithaya Chareonthaitawee; Rob S Beanlands; Wengen Chen; Sharmila Dorbala; Edward J Miller; Venkatesh L Murthy; David H Birnie; Edward S Chen; Leslie T Cooper; Roderick H Tung; Eric S White; Salvador Borges-Neto; Marcelo F Di Carli; Robert J Gropler; Terrence D Ruddy; Thomas H Schindler; Ron Blankstein Journal: J Nucl Med Date: 2017-08 Impact factor: 10.057
Authors: Ammar M Killu; Nishaki Mehta; Qi Zheng; Piotr Sobieszczyk; Usha B Tedrow; William G Stevenson; Roy M John Journal: J Interv Card Electrophysiol Date: 2018-03-24 Impact factor: 1.900
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Sáenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Europace Date: 2019-08-01 Impact factor: 5.214
Authors: Toby Rogers; Kanishka Ratnayaka; Parag Karmarkar; Adrienne E Campbell-Washburn; William H Schenke; Jonathan R Mazal; Ozgur Kocaturk; Anthony Z Faranesh; Robert J Lederman Journal: JACC Basic Transl Sci Date: 2016-08