Diagnostic Value of Endomyocardial Biopsy Guided by Electroanatomic Voltage Mapping in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

  1. ANDREA AVELLA M.D.1,
  2. GIULIA D'AMATI M.D., Ph.D.2,
  3. AUGUSTO PAPPALARDO M.D.1,
  4. FEDERICA RE M.D.1,
  5. PAOLA FRANCESCA SILENZI M.D.2,
  6. FRANCESCO LAURENZI M.D.1,
  7. PIERGIUSEPPE DE GIROLAMO M.D.1,
  8. GEMMA PELARGONIO M.D.1,
  9. ANTONIO DELLO RUSSO M.D., Ph.D.1,
  10. PASQUALE BARATTA M.D.1,
  11. GIUSEPPE MESSINA M.D.1,
  12. PAOLO ZECCHI M.D.1,
  13. ELISABETTA ZACHARA M.D.1,
  14. CLAUDIO TONDO M.D., Ph.D.1

Article first published online: 28 JUN 2008

DOI: 10.1111/j.1540-8167.2008.01228.x

Issue

Journal of Cardiovascular Electrophysiology

Journal of Cardiovascular Electrophysiology

Volume 19, Issue 11, pages 1127–1134, November 2008

Additional Information

How to Cite

AVELLA, A., D'AMATI, G., PAPPALARDO, A., RE, F., SILENZI, P. F., LAURENZI, F., DE GIROLAMO, P., PELARGONIO, G., RUSSO, A. D., BARATTA, P., MESSINA, G., ZECCHI, P., ZACHARA, E. and TONDO, C. (2008), Diagnostic Value of Endomyocardial Biopsy Guided by Electroanatomic Voltage Mapping in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Journal of Cardiovascular Electrophysiology, 19: 1127–1134. doi: 10.1111/j.1540-8167.2008.01228.x

Author Information

  1. 1

    Cardiology Division, Cardiac Arrhythmia and Heart Failure Research Institute, St. Camillo-Forlanini Hospital/Catholic University of Sacred Heart, Rome, Italy

  2. 2

    Department of Experimental Medicine, Sapienza University, Rome, Italy

*Address for correspondence: Andrea Avella, M.D., Cardiology Division, Cardiac Arrhythmia and Heart Failure Research Institute, St. Camillo-Forlanini Hospital/Catholic University of Sacred Heart, Via Portuense 332, 00149 Rome, Italy. Tel/Fax: +39-06-8546155; E-mail: andrea.avella@tin.it

Publication History

  1. Issue published online: 5 NOV 2008
  2. Article first published online: 28 JUN 2008

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Keywords:

  • cardiomyopathy;
  • right ventricle;
  • arrhythmia;
  • mapping;
  • biopsy

Introduction: To improve the endomyocardial biopsy (EMB) diagnostic sensitivity for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), we hypothesized a biopsy sampling focused on selected right ventricle (RV) low-voltage areas identified by electroanatomic voltage mapping.

Methods and Results: The study population (22 patients, 10 men; mean age 34 ± 10 years) included 11 patients with overt ARVC/D (group A) and 11 patients with suspected ARVC/D (group B), according to both arrhythmic profile and standardized noninvasive diagnostic criteria. In all 22 patients, an RV bipolar voltage mapping was performed with CARTO™ system sampling multiple endocardial sites (262 ± 61), during sinus rhythm, with a 0.5–1.5 mV color range setting of voltage display. All 11 (100%) group A patients and 8 of the 11 (73%) group B patients (P = nonsignificant [NS]) presented RV low-voltage areas (<0.5 mV). In 8 group A patients and in all 8 group B patients with a pathological RV voltage map, an EMB focused on the low-voltage areas was performed. In 6 (75%) group A patients and in 7 (87%) group B patients (P = NS), voltage mapping-guided EMB was diagnostic for ARVC/D. In the remaining 3 patients, only nonspecific histological findings were observed.

Conclusions: The results of our study (1) confirm the high diagnostic sensitivity of RV voltage mapping in patients with overt ARVC/D, (2) document a high prevalence of RV low-voltage areas even in patients with suspected ARVC/D, and (3) demonstrate that in patients with clinical evidence or suspicion for ARVC/D, presenting RV low-voltage areas, EMB guided by voltage mapping may provide ARVC/D diagnosis confirmation.

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