Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Endowed Professor
|Targeted Endomyocardial Biopsy Using Electroanatomical Voltage Mapping for Patients Suspected of Cardiac Sarcoidosis
|The 79th Annual Scientific Meeting of the Japanese Circulation Society
|Japanese Circulation Society
|Publisher and common publisher
|◎SERIZAWA Naoki, SHODA Morio, YOSHIDA Ayano, SUZUKI Tsuyoshi, EJIMA Koichiro, SHIGA Tsuyoshi, HAGIWARA Nobuhisa
(city and name of the country)
|Purpose: Diagnosing cardiac sarcoidosis (CS) is sometimes very challenging due to lack of typical signs. Although a histological diagnosis is crucial of diagnosing CS, the sensitivity of endomyocardial biopsy (EMB) is low. We evaluated the diagnostic contribution of electroanatomical voltage mapping (EVM)-guided EMB in patients with CS. Methods: We studied 12 consecutive patients with a noninvasive probable diagnosis of CS according to current criteria (Japanese Diagnostic Standard and Guideline for Sarcoidosis 2006) and without specific histological findings of CS by traditional EMB. All patients underwent EVM-guided EMB. Intracardiac electrogram voltage amplitude and duration time at biopsy sites were measured manually during the procedure. Results: In all 12 patients, RV bipolar voltage mapping was performed with a 3-D electroanatomical mapping system, and the low voltage area ( < 1.5 mV) was identified at outflow tract and interventricular septum of the RV. Histological samples taken from the low voltage area by a standard bioptome with deflectable long sheath showed typical histopathological findings of CS in 5 patients (42%). Positive biopsy sites were lower voltage amplitude and longer duration time than negative biopsy sites (0.63 vs. 2.64 mV, p=0.051 and 142 vs. 81 ms, p=0.013, respectively). No complication occurred throughout the procedure. Conclusion: EVM-guided EMB is helpful in confirming the diagnosis of CS in probable CS patients who remain undiagnosed by traditional EMB.