A Precise Endomyocardial Biopsy Method Guided by the Electroanatomical Mapping System

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00320. Epub November 18, 2024.

Endomyocardial biopsy (EMB) is a valuable tool in cardiac diagnostics but is limited by low diagnostic yield and significant complication risks. Here, we report a precise EMB procedure in a patient with unexplained heart failure under guidance of an electroanatomical mapping system (EAM), which can avoid the complications of cardiac tamponade and arrhythmias.

Intracardiac echocardiography (ICE) was used to construct a 3-dimensional geometry model of the heart’s anatomic structures on the CartoSound system (Johnson & Johnson) (Figure A). Then, a DECANAV electrophysiology catheter (Johnson & Johnson) mapped the potential locations of the His-bundle and the right bundle branch (Figure B). If needed, the potential location of the left bundle branch can be mapped on the left ventricular septal plane through the femoral artery approach.

Under the guidance of the EAM system, a clip-pin cable was used to connect a biopsy needle to the EAM system for navigation. In brief, one side of the connector was clipped onto the tail of the biopsy needle, while the other side was connected to the pin-box (Figure C). The biopsy needle was then inserted into the guide catheter with the biopsy needle tip protruding slightly out of the catheter, which enables the biopsy needle to be visible in the EAM system (Figure D). Next, the biopsy needle was adjusted to the target myocardial tissue for myocardial biopsy.

Compared with conventional EMB, this technique can effectively avoid damage to the thinner cardiac myocardium and conduction system. The target myocardial tissue can also be accurately captured via visualization of the biopsy needle under the EAM and real-time intracardiac ultrasound images, thereby improving the accuracy of EMB.

Affiliations and Disclosures

Xin Liu, MD; Jun Lu, MD; Fengqiang Xu, MD; Bingxue Song, MD; Ning Zhang, MD; Yongfang Guo, MD; Yingying Zhang, MD; Haichu Yu, MD

From The Affiliated Hospital of Qingdao University, Department of Cardiology, Qingdao University, Qingdao, China.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Consent statement:  The authors confirm that informed consent was obtained from the patient prior to the interventions described in the manuscript.

Address for correspondence: Haichu Yu, MD, The Affiliated Hospital of Qingdao University, Department of Cardiology, Qingdao University, 266000, Qingdao, China. Email: haichuyu@163.com