Novel technique and assessment of available 3-dimensional delivery sheath for endomyocardial biopsy during cardiac device implantation

Koji Sudo; Kenji Kuroki; Kazuto Nakamura; Yosuke Watanabe; Manabu Uematsu; Chisa Asahina; Yuya Tanaka; Tsuyoshi Kobayashi; Akira Sato

doi:10.1016/j.hrthm.2024.10.069

Novel technique and assessment of available 3-dimensional delivery sheath for endomyocardial biopsy during cardiac device implantation

Heart Rhythm. 2024 Nov 6:S1547-5271(24)03534-3. doi: 10.1016/j.hrthm.2024.10.069. Online ahead of print.

Authors

Koji Sudo¹, Kenji Kuroki², Kazuto Nakamura¹, Yosuke Watanabe¹, Manabu Uematsu¹, Chisa Asahina¹, Yuya Tanaka¹, Tsuyoshi Kobayashi¹, Akira Sato¹

Affiliations

¹ Department of Cardiovascular Medicine, University of Yamanashi, Chuo, Japan.
² Department of Cardiovascular Medicine, University of Yamanashi, Chuo, Japan. Electronic address: kkuroki@yamanashi.ac.jp.

PMID: 39515505
DOI: 10.1016/j.hrthm.2024.10.069

Abstract

Background: Early cardiomyopathy diagnosis allows timely treatment and may help resolve problems that occur after cardiac implantable electronic device (CIED) implantation.

Objective: This study aims to describe a novel technique for endomyocardial biopsy (EMB) using a 3-dimensional (3D) delivery sheath during CIED implantation. In addition, we investigated 3D delivery-sheath characteristics using sheath deflection during bioptome insertion.

Methods: This study of 20 patients undergoing CIED implantation analyzed the EMB success rate and pathologic findings. Fluoroscopic images assessed 3D delivery sheath characteristics before and after bioptome insertion in 3 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, Berlin, Germany), CSP Locator 3D (Abbott, Chicago, IL), and SSPC (Boston Scientific, Marlborough, MA) (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).

Results: Among the 3 sheaths, only the CSP Locator 3D and Selectra 3D showed significant differences in Dis-RAO (13.2 ± 2.0 mm vs 19.8 ± 3.8 mm, P < .01) and Dis-LAO (8.1 ± 1.3 mm vs 15.3 ± 3.9 mm, P < .01). A total of 77 EMB samples from 20 patients were collected without any complication, and 4 patients (20%) were diagnosed with cardiac amyloidosis (CA) based on pathologic findings.

Conclusion: All 3D delivery sheaths were safe and effective for performing EMB from the RVS during CIED implantation, enabling early CA diagnosis in 20% of patients.

Keywords: 3-dimensional delivery sheath; Atrioventricular block; Cardiac amyloidosis; Cardiac implantable electronic device; Endomyocardial biopsy; Transthyretin amyloidosis with cardiomyopathy.