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

Vaibhav R. Vaidya, Anas A. Abudan, Krithika Vasudevan, Ghanshyam Shantha, Leslie T Jr. Cooper, Suraj Kapa, Peter Noseworthy, Yong-Mei Cha, Samuel J Asirvatham, Abhishek J. Deshmukh

Research output: Contribution to journalArticle

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jul 12 2018

Keywords

  • Arrhythmogenic right ventricular cardiomyopathy
  • Cardiac sarcoidosis
  • Electroanatomical mapping
  • Endomyocardial biopsy
  • Lymphocytic myocarditis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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