Novel technique and assessment of available three-dimensional delivery sheath for endomyocardial biopsy during cardiac device implantation

Abstract

BackgroundEarly cardiomyopathy diagnosis allows timely treatment and may help resolve problems that occur after cardiac implantable electronic device (CIED) implantation. ObjectiveTo describe a novel technique for endomyocardial biopsy (EMB) using a three-dimensional (3D) delivery sheath during CIED implantation. Additionally, we investigated 3D delivery sheath characteristics using sheath deflection during bioptome insertion. MethodsThis study of 20 patients undergoing CIED implantation analyzed the EMB success rate and pathological findings. Fluoroscopic images assessed 3D delivery sheath characteristics before and after bioptome insertion in three sheaths. CIEDs were implanted for sick sinus syndrome (n=3), atrioventricular conduction disorder (n=16), and left ventricular dysfunction (n=1). Fluoroscopic verification was performed using right anterior oblique (RAO) and left anterior oblique (LAO) views. EMB was performed with Selectra 3D (BIOTRONIK), CSP Locator 3D (Abbott) and SSPC (Boston Scientific) (12, 4, and 4 patients, respectively). The distance moved toward the right ventricular apex (RVA) in RAO was defined as Dis-RAO (mm) and that moved toward the RVA in LAO was defined as Dis-LAO (mm). ResultsAmong the three sheaths, only the CSP Locator 3D and Selectra 3D showed significant differences in Dis-RAO (13.2±2.0mm vs. 19.8±3.8mm, p<0.01) and Dis-LAO (8.1±1.3mm vs. 15.3±3.9mm, p<0.01). A total of 77 EMB samples from 20 patients were collected without any complication, and four patients (20%) were diagnosed with cardiac amyloidosis (CA) based on pathological findings. ConclusionsAll 3D delivery sheaths were safe and effective for performing EMB from the RVS during CIED implantation, enabling early CA diagnosis in 20% of patients.