The feasibility and safety of Endomyocardial Biopsy by lumenless pacing lead-sheath directed method during the Cardiac Implantable Electronic Device implantation

Yang Ye; Youyou Chen; Hao Jiang; Jiling Zeng; Xingchen Wang; Ying Yang; Xiang Lan Liu; XuLin Hong; Bei Wang; Ya Xun Sun; Dongwu Lai; Xi-Qi Xu; Guo-Sheng Fu

doi:10.1016/j.hrthm.2024.11.018

The feasibility and safety of Endomyocardial Biopsy by lumenless pacing lead-sheath directed method during the Cardiac Implantable Electronic Device implantation

Heart Rhythm. 2024 Nov 15:S1547-5271(24)03571-9. doi: 10.1016/j.hrthm.2024.11.018. Online ahead of print.

Authors

Yang Ye¹, Youyou Chen², Hao Jiang³, Jiling Zeng⁴, Xingchen Wang¹, Ying Yang¹, Xiang Lan Liu¹, XuLin Hong¹, Bei Wang⁵, Ya Xun Sun¹, Dongwu Lai⁶, Xi-Qi Xu⁷, Guo-Sheng Fu⁸

Affiliations

¹ Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No.3 Qing chun East Road, Hangzhou 310016, Zhejiang, People's Republic of China; Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province.
² Department of Cardiology, The First People's Hospital of Wenling,333 Chuan'an South Road, Chengxi Street, Wenling City, 317500, Zhejiang Province, China.
³ Department of Hematology and Cell Therapy, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University.
⁴ Department of Pathology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University.
⁵ Department of Cardiac Echocardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.
⁶ Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No.3 Qing chun East Road, Hangzhou 310016, Zhejiang, People's Republic of China; Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province. Electronic address: laidw@zju.edu.cn.
⁷ Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Dongcheng District, Beijing 100730, China. Electronic address: xuxiqi0928@163.com.
⁸ Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No.3 Qing chun East Road, Hangzhou 310016, Zhejiang, People's Republic of China; Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province. Electronic address: fugs@zju.edu.cn.

PMID: 39551121
DOI: 10.1016/j.hrthm.2024.11.018

Abstract

Background: Patients with cardiovascular implantable electronic devices (CIEDs) indication 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 peri-procedural 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 to the traditional bioptome method (T-B-M).

Methods: Consecutive eighty 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: 380 RV EMBs procedures were performed with comparable 4.1±0.8 in the L-S-M group and 3.8±0.8 samples/patient in the T-B-M group. In the L-S-M group, seven (11.7%) patients experienced minor complications with 3 transient right bundle branch block, 2 transient atrioventricular block (AVB) and 2 regional minor device pocket hematomas. In the T-B-M group, three (15%) experienced one temporary pacing for transient AVB, one chest discomfort and one regional hematoma. No cardiac tamponade was detected.

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

Keywords: Cardiomyopathy; Cardiovascular implantable electronic devices; Endomyocardial biopsy; bioptome method; lead delivery sheath; lumenless pacing lead.