Value of 3D mapping-guided endomyocardial biopsy in cardiac sarcoidosis: Case series and narrative review on the value of electro-anatomic mapping-guided endomyocardial biopsies
Integration of endomyocardial biopsy (EMB) in the diagnostic workup of cardiac sarcoidosis (CS) is under-recognized in current clinical practice, since capturing focal granulomas is challenging. Our aim was to describe our experience with electro-anatomic mapping (EAM)-guided EMB and provide a compr...
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| Veröffentlicht in: | European journal of clinical investigation 2021-04, Vol.51 (4), p.e13497-e13497 |
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| container_title | European journal of clinical investigation |
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| creator | Haanschoten, Danielle M Adiyaman, Ahmet 't Hart, Nils A Jager, Piet L Elvan, Arif |
| description | Integration of endomyocardial biopsy (EMB) in the diagnostic workup of cardiac sarcoidosis (CS) is under-recognized in current clinical practice, since capturing focal granulomas is challenging. Our aim was to describe our experience with electro-anatomic mapping (EAM)-guided EMB and provide a comprehensive review of the literature.
Five patients (age 49.4 ± 11.4) with suspected CS underwent EAM-guided EMB in Isala Heart Center (Zwolle, the Netherlands) between 2017 and 2019. In all patients, a 3D bipolar voltage map ( |
| doi_str_mv | 10.1111/eci.13497 |
| format | Article |
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Five patients (age 49.4 ± 11.4) with suspected CS underwent EAM-guided EMB in Isala Heart Center (Zwolle, the Netherlands) between 2017 and 2019. In all patients, a 3D bipolar voltage map (<0.5-1.5 mV) and unipolar voltage map (LV < 8.3 mV, RV < 5.5 mV) was created using a high-density mapping catheter. The bioptome was connected to the mapping system to guide targeted EMB. Biopsy samples (2-9 samples) were taken from both LV and RV sites, guided by EAM and areas with abnormal electrograms, without complications. CS diagnosis was based on EMB in 2/5 patients. A granuloma was captured in one patient at the LV basal septum with normal bipolar and abnormal unipolar voltage. All patients with delayed enhancement on cardiac magnetic resonance, revealed fibrosis in the biopsy sample. In one patient with suspected isolated cardiac sarcoidosis, diagnosis could not be confirmed by histopathology analysis, while unipolar voltage mapping was abnormal and diastolic potentials were present. Literature search revealed 7 reports (18 patients) describing EAM-guided EMB in CS patients, with 100% of the EMB taken form the RV.
Unipolar voltage mapping may be superior to target active inflamed tissue and should be evaluated in future research regarding EAM-guided EMB in CS.</description><identifier>ISSN: 0014-2972</identifier><identifier>EISSN: 1365-2362</identifier><identifier>DOI: 10.1111/eci.13497</identifier><identifier>PMID: 33482016</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Biopsy ; Catheters ; Complications ; Diagnosis ; Electric potential ; Fibrosis ; Granuloma ; Heart ; Histopathology ; Inflammation ; Literature reviews ; Magnetic resonance ; Mapping ; Medical instruments ; Patients ; Sarcoidosis ; Septum ; Voltage</subject><ispartof>European journal of clinical investigation, 2021-04, Vol.51 (4), p.e13497-e13497</ispartof><rights>2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 Stichting European Society for Clinical Investigation Journal Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c273t-c36226cdb4ed191dbb425956df63f198ae56e6180719b36d8f920b475d64710e3</cites><orcidid>0000-0003-1112-5928</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33482016$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haanschoten, Danielle M</creatorcontrib><creatorcontrib>Adiyaman, Ahmet</creatorcontrib><creatorcontrib>'t Hart, Nils A</creatorcontrib><creatorcontrib>Jager, Piet L</creatorcontrib><creatorcontrib>Elvan, Arif</creatorcontrib><title>Value of 3D mapping-guided endomyocardial biopsy in cardiac sarcoidosis: Case series and narrative review on the value of electro-anatomic mapping-guided endomyocardial biopsies</title><title>European journal of clinical investigation</title><addtitle>Eur J Clin Invest</addtitle><description>Integration of endomyocardial biopsy (EMB) in the diagnostic workup of cardiac sarcoidosis (CS) is under-recognized in current clinical practice, since capturing focal granulomas is challenging. Our aim was to describe our experience with electro-anatomic mapping (EAM)-guided EMB and provide a comprehensive review of the literature.
Five patients (age 49.4 ± 11.4) with suspected CS underwent EAM-guided EMB in Isala Heart Center (Zwolle, the Netherlands) between 2017 and 2019. In all patients, a 3D bipolar voltage map (<0.5-1.5 mV) and unipolar voltage map (LV < 8.3 mV, RV < 5.5 mV) was created using a high-density mapping catheter. The bioptome was connected to the mapping system to guide targeted EMB. Biopsy samples (2-9 samples) were taken from both LV and RV sites, guided by EAM and areas with abnormal electrograms, without complications. CS diagnosis was based on EMB in 2/5 patients. A granuloma was captured in one patient at the LV basal septum with normal bipolar and abnormal unipolar voltage. All patients with delayed enhancement on cardiac magnetic resonance, revealed fibrosis in the biopsy sample. In one patient with suspected isolated cardiac sarcoidosis, diagnosis could not be confirmed by histopathology analysis, while unipolar voltage mapping was abnormal and diastolic potentials were present. Literature search revealed 7 reports (18 patients) describing EAM-guided EMB in CS patients, with 100% of the EMB taken form the RV.
Unipolar voltage mapping may be superior to target active inflamed tissue and should be evaluated in future research regarding EAM-guided EMB in CS.</description><subject>Biopsy</subject><subject>Catheters</subject><subject>Complications</subject><subject>Diagnosis</subject><subject>Electric potential</subject><subject>Fibrosis</subject><subject>Granuloma</subject><subject>Heart</subject><subject>Histopathology</subject><subject>Inflammation</subject><subject>Literature reviews</subject><subject>Magnetic resonance</subject><subject>Mapping</subject><subject>Medical instruments</subject><subject>Patients</subject><subject>Sarcoidosis</subject><subject>Septum</subject><subject>Voltage</subject><issn>0014-2972</issn><issn>1365-2362</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqNkU1P3DAQhq2qqCy0B_4AstQLHAL-ihNzQ9sPkFbiQnuNHHuyGCV2sJNF-7P4h7hd4MCJuYw0evTOaB6Ejig5o7nOwbgzyoWqPqEF5bIsGJfsM1oQQkXBVMX20UFK94SQmnL2Be1zLmpGqFygp7-6nwGHDvMfeNDj6Py6WM_OgsXgbRi2wehone5x68KYtth5vJsYnHQ0wdmQXLrAS50AJ4gOEtbeYq9j1JPbAI6wcfCIg8fTHeDN60LowUwxFNrrKQzOfGR9Dv-K9jrdJ_j20g_Rn18_b5dXxerm9_XyclUYVvGpMPkFTBrbCrBUUdu2gpWqlLaTvKOq1lBKkLQmFVUtl7buFCOtqEorRUUJ8EN0sssdY3iYIU3N4JKBvtcewpwaJmrCSlJyktHv79D7MEefr8uUUrUUSrBMne4oE0NKEbpmjG7QcdtQ0vzz2GSPzX-PmT1-SZzbAewb-SqOPwOsL5rm</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Haanschoten, Danielle M</creator><creator>Adiyaman, Ahmet</creator><creator>'t Hart, Nils A</creator><creator>Jager, Piet L</creator><creator>Elvan, Arif</creator><general>Blackwell Publishing Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1112-5928</orcidid></search><sort><creationdate>202104</creationdate><title>Value of 3D mapping-guided endomyocardial biopsy in cardiac sarcoidosis: Case series and narrative review on the value of electro-anatomic mapping-guided endomyocardial biopsies</title><author>Haanschoten, Danielle M ; Adiyaman, Ahmet ; 't Hart, Nils A ; Jager, Piet L ; Elvan, Arif</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c273t-c36226cdb4ed191dbb425956df63f198ae56e6180719b36d8f920b475d64710e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Biopsy</topic><topic>Catheters</topic><topic>Complications</topic><topic>Diagnosis</topic><topic>Electric potential</topic><topic>Fibrosis</topic><topic>Granuloma</topic><topic>Heart</topic><topic>Histopathology</topic><topic>Inflammation</topic><topic>Literature reviews</topic><topic>Magnetic resonance</topic><topic>Mapping</topic><topic>Medical instruments</topic><topic>Patients</topic><topic>Sarcoidosis</topic><topic>Septum</topic><topic>Voltage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haanschoten, Danielle M</creatorcontrib><creatorcontrib>Adiyaman, Ahmet</creatorcontrib><creatorcontrib>'t Hart, Nils A</creatorcontrib><creatorcontrib>Jager, Piet L</creatorcontrib><creatorcontrib>Elvan, Arif</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of clinical investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haanschoten, Danielle M</au><au>Adiyaman, Ahmet</au><au>'t Hart, Nils A</au><au>Jager, Piet L</au><au>Elvan, Arif</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Value of 3D mapping-guided endomyocardial biopsy in cardiac sarcoidosis: Case series and narrative review on the value of electro-anatomic mapping-guided endomyocardial biopsies</atitle><jtitle>European journal of clinical investigation</jtitle><addtitle>Eur J Clin Invest</addtitle><date>2021-04</date><risdate>2021</risdate><volume>51</volume><issue>4</issue><spage>e13497</spage><epage>e13497</epage><pages>e13497-e13497</pages><issn>0014-2972</issn><eissn>1365-2362</eissn><abstract>Integration of endomyocardial biopsy (EMB) in the diagnostic workup of cardiac sarcoidosis (CS) is under-recognized in current clinical practice, since capturing focal granulomas is challenging. Our aim was to describe our experience with electro-anatomic mapping (EAM)-guided EMB and provide a comprehensive review of the literature.
Five patients (age 49.4 ± 11.4) with suspected CS underwent EAM-guided EMB in Isala Heart Center (Zwolle, the Netherlands) between 2017 and 2019. In all patients, a 3D bipolar voltage map (<0.5-1.5 mV) and unipolar voltage map (LV < 8.3 mV, RV < 5.5 mV) was created using a high-density mapping catheter. The bioptome was connected to the mapping system to guide targeted EMB. Biopsy samples (2-9 samples) were taken from both LV and RV sites, guided by EAM and areas with abnormal electrograms, without complications. CS diagnosis was based on EMB in 2/5 patients. A granuloma was captured in one patient at the LV basal septum with normal bipolar and abnormal unipolar voltage. All patients with delayed enhancement on cardiac magnetic resonance, revealed fibrosis in the biopsy sample. In one patient with suspected isolated cardiac sarcoidosis, diagnosis could not be confirmed by histopathology analysis, while unipolar voltage mapping was abnormal and diastolic potentials were present. Literature search revealed 7 reports (18 patients) describing EAM-guided EMB in CS patients, with 100% of the EMB taken form the RV.
Unipolar voltage mapping may be superior to target active inflamed tissue and should be evaluated in future research regarding EAM-guided EMB in CS.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>33482016</pmid><doi>10.1111/eci.13497</doi><orcidid>https://orcid.org/0000-0003-1112-5928</orcidid></addata></record> |
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| subjects | Biopsy Catheters Complications Diagnosis Electric potential Fibrosis Granuloma Heart Histopathology Inflammation Literature reviews Magnetic resonance Mapping Medical instruments Patients Sarcoidosis Septum Voltage |
| title | Value of 3D mapping-guided endomyocardial biopsy in cardiac sarcoidosis: Case series and narrative review on the value of electro-anatomic mapping-guided endomyocardial biopsies |
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