Feasibility of Combined Unipolar and Bipolar Voltage Maps to Improve Sensitivity of Endomyocardial Biopsy

Michela Casella, Francesca Pizzamiglio, Antonio Dello Russo, Corrado Carbucicchio, Ghaliah Al-Mohani, Eleonora Russo, Pasquale Notarstefano, Maurizio Pieroni, Giulia D'Amati, Elena Sommariva, Marta Giovannardi, Andrea Carnevali, Stefania Riva, Gaetano Fassini, Fabrizio Tundo, Pasquale Santangeli, Luigi Di Biase, Leonardo Bolognese, Andrea Natale, Claudio Tondo

Research output: Contribution to journalArticle

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Abstract

Background - Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases. Methods and Results - We performed endocardial bipolar EVM-guided EMBs in 29 patients and we analyzed unipolar EVM at withdrawal sites. Eighty myocardial samples were collected (mean, 2.8±0.9; median, 3 fragments per patient) and 60 were suitable for histological analysis. Ten specimens (17%) were collected from an area with discordant normal bipolar/low-voltage unipolar EVM and they were diagnostic or suggestive for arrhythmogenic right ventricular dysplasia/cardiomyopathy in 6 patients, for myocarditis and sarcoidosis in 1 patient each. Six samples (10%) were collected from an area with discordant low-voltage bipolar/normal unipolar EVM and they showed nonspecific features. The sensitivity of unipolar EVMs for a diagnostic biopsy finding EMB was significantly higher compared with bipolar EVMs analyzed according to samples (P<0.01) and patients (P=0.008). The specificity of unipolar EMB was better than bipolar EMB when analyzed for all samples (P=0.0014) but the difference did not reach statistical significance when analyzed by patient (P=0.083). The diagnostic yield was 63.3% for the bipolar and 83.3% for the unipolar EVM. Conclusions - These findings suggest that use of a combined bipolar/unipolar map may be able to improve the diagnostic yield of endomyocardial ventricular biopsy.

Original languageEnglish (US)
Pages (from-to)625-632
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number3
DOIs
StatePublished - Jun 4 2015

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Biopsy
Arrhythmogenic Right Ventricular Dysplasia
Myocarditis
Sarcoidosis

Keywords

  • arrhythmogenic right ventricular dysplasia
  • myocarditis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Casella, M., Pizzamiglio, F., Dello Russo, A., Carbucicchio, C., Al-Mohani, G., Russo, E., ... Tondo, C. (2015). Feasibility of Combined Unipolar and Bipolar Voltage Maps to Improve Sensitivity of Endomyocardial Biopsy. Circulation: Arrhythmia and Electrophysiology, 8(3), 625-632. https://doi.org/10.1161/CIRCEP.114.002216

Feasibility of Combined Unipolar and Bipolar Voltage Maps to Improve Sensitivity of Endomyocardial Biopsy. / Casella, Michela; Pizzamiglio, Francesca; Dello Russo, Antonio; Carbucicchio, Corrado; Al-Mohani, Ghaliah; Russo, Eleonora; Notarstefano, Pasquale; Pieroni, Maurizio; D'Amati, Giulia; Sommariva, Elena; Giovannardi, Marta; Carnevali, Andrea; Riva, Stefania; Fassini, Gaetano; Tundo, Fabrizio; Santangeli, Pasquale; Di Biase, Luigi; Bolognese, Leonardo; Natale, Andrea; Tondo, Claudio.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 3, 04.06.2015, p. 625-632.

Research output: Contribution to journalArticle

Casella, M, Pizzamiglio, F, Dello Russo, A, Carbucicchio, C, Al-Mohani, G, Russo, E, Notarstefano, P, Pieroni, M, D'Amati, G, Sommariva, E, Giovannardi, M, Carnevali, A, Riva, S, Fassini, G, Tundo, F, Santangeli, P, Di Biase, L, Bolognese, L, Natale, A & Tondo, C 2015, 'Feasibility of Combined Unipolar and Bipolar Voltage Maps to Improve Sensitivity of Endomyocardial Biopsy', Circulation: Arrhythmia and Electrophysiology, vol. 8, no. 3, pp. 625-632. https://doi.org/10.1161/CIRCEP.114.002216
Casella, Michela ; Pizzamiglio, Francesca ; Dello Russo, Antonio ; Carbucicchio, Corrado ; Al-Mohani, Ghaliah ; Russo, Eleonora ; Notarstefano, Pasquale ; Pieroni, Maurizio ; D'Amati, Giulia ; Sommariva, Elena ; Giovannardi, Marta ; Carnevali, Andrea ; Riva, Stefania ; Fassini, Gaetano ; Tundo, Fabrizio ; Santangeli, Pasquale ; Di Biase, Luigi ; Bolognese, Leonardo ; Natale, Andrea ; Tondo, Claudio. / Feasibility of Combined Unipolar and Bipolar Voltage Maps to Improve Sensitivity of Endomyocardial Biopsy. In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 3. pp. 625-632.
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T1 - Feasibility of Combined Unipolar and Bipolar Voltage Maps to Improve Sensitivity of Endomyocardial Biopsy

AU - Casella, Michela

AU - Pizzamiglio, Francesca

AU - Dello Russo, Antonio

AU - Carbucicchio, Corrado

AU - Al-Mohani, Ghaliah

AU - Russo, Eleonora

AU - Notarstefano, Pasquale

AU - Pieroni, Maurizio

AU - D'Amati, Giulia

AU - Sommariva, Elena

AU - Giovannardi, Marta

AU - Carnevali, Andrea

AU - Riva, Stefania

AU - Fassini, Gaetano

AU - Tundo, Fabrizio

AU - Santangeli, Pasquale

AU - Di Biase, Luigi

AU - Bolognese, Leonardo

AU - Natale, Andrea

AU - Tondo, Claudio

PY - 2015/6/4

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N2 - Background - Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases. Methods and Results - We performed endocardial bipolar EVM-guided EMBs in 29 patients and we analyzed unipolar EVM at withdrawal sites. Eighty myocardial samples were collected (mean, 2.8±0.9; median, 3 fragments per patient) and 60 were suitable for histological analysis. Ten specimens (17%) were collected from an area with discordant normal bipolar/low-voltage unipolar EVM and they were diagnostic or suggestive for arrhythmogenic right ventricular dysplasia/cardiomyopathy in 6 patients, for myocarditis and sarcoidosis in 1 patient each. Six samples (10%) were collected from an area with discordant low-voltage bipolar/normal unipolar EVM and they showed nonspecific features. The sensitivity of unipolar EVMs for a diagnostic biopsy finding EMB was significantly higher compared with bipolar EVMs analyzed according to samples (P<0.01) and patients (P=0.008). The specificity of unipolar EMB was better than bipolar EMB when analyzed for all samples (P=0.0014) but the difference did not reach statistical significance when analyzed by patient (P=0.083). The diagnostic yield was 63.3% for the bipolar and 83.3% for the unipolar EVM. Conclusions - These findings suggest that use of a combined bipolar/unipolar map may be able to improve the diagnostic yield of endomyocardial ventricular biopsy.

AB - Background - Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases. Methods and Results - We performed endocardial bipolar EVM-guided EMBs in 29 patients and we analyzed unipolar EVM at withdrawal sites. Eighty myocardial samples were collected (mean, 2.8±0.9; median, 3 fragments per patient) and 60 were suitable for histological analysis. Ten specimens (17%) were collected from an area with discordant normal bipolar/low-voltage unipolar EVM and they were diagnostic or suggestive for arrhythmogenic right ventricular dysplasia/cardiomyopathy in 6 patients, for myocarditis and sarcoidosis in 1 patient each. Six samples (10%) were collected from an area with discordant low-voltage bipolar/normal unipolar EVM and they showed nonspecific features. The sensitivity of unipolar EVMs for a diagnostic biopsy finding EMB was significantly higher compared with bipolar EVMs analyzed according to samples (P<0.01) and patients (P=0.008). The specificity of unipolar EMB was better than bipolar EMB when analyzed for all samples (P=0.0014) but the difference did not reach statistical significance when analyzed by patient (P=0.083). The diagnostic yield was 63.3% for the bipolar and 83.3% for the unipolar EVM. Conclusions - These findings suggest that use of a combined bipolar/unipolar map may be able to improve the diagnostic yield of endomyocardial ventricular biopsy.

KW - arrhythmogenic right ventricular dysplasia

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