Feasibility and safety of endomyocardial biopsy by lumenless pacing lead sheath-directed method during cardiac implantable electronic device implantation

Background: Patients with an indication for a cardiovascular implantable electronic device (CIED) are complicated with special cardiomyopathy or other unspecified cardiac abnormalities and may need endomyocardial biopsy (EMB). However, EMB by a bioptome is usually avoided to reduce the risk of lead displacement in the CIED periprocedural period.

Objective: We aimed to assess the safety and feasibility of a novel approach for transvenous right ventricular (RV) EMB using the lead sheath method (L-S-M) during CIED implantation and compared it with the traditional bioptome method (T-B-M).

Methods: A consecutive 80 patients referred for EMB were enrolled. In the L-S-M group, a sheath with a lumenless pacing lead was positioned toward the middle to apical interventricular septum under fluoroscopy (n = 60). The CIED implantation was performed through the same venous access site. In the T-B-M group, a bioptome was used (n = 20). The clinical characteristics, procedural details, success rate, and complications were evaluated.

Results: There were 380 RV EMB procedures performed with comparable numbers of samples per patient, 4.1 ± 0.8 in the L-S-M group and 3.8 ± 0.8 in the T-B-M group. In the L-S-M group, 7 (11.7%) patients experienced minor complications with 3 transient right bundle branch blocks, 2 transient atrioventricular blocks, and 2 regional minor device pocket hematomas. In the T-B-M group, 3 (15%) experienced 1 temporary pacing for transient atrioventricular block, 1 chest discomfort, and 1 regional hematoma. No cardiac tamponade was detected.

Conclusion: RV EMB by the innovative L-S-M is technically feasible and safe. It can yield valuable and early diagnostic insights for patients who are candidates for CIEDs.