Should add-hoc cardiac biopsy be routine in patients with cardiomyopathy of unknown etiology undergoing electrical storm ablation?

Abstract

Sarcoidosis is a multisystem disorder of unknown etiology characterized by non-necrotizing and non-caseating granuloma formation in pulmonary tissue and extrapulmonary organs, such as the skin, lymph nodes, and the heart.1 Myocardial involvement is characterized by the development of atrioventricular block, congestive heart failure, ventricular tachycardia (VT), and sudden cardiac death. In autopsy studies, 20% to 70% of patients with recognized extracardiac sarcoid have subclinical cardiac involvement.2 Sustained monomorphic VT in cardiac sarcoidosis (CS) is a significant predictor of mortality.3 The management of VT in patients with CS is challenging, owing to the complexity of the underlying substrate and the progressive nature of the inflammatory process. Besides, the management of VT is much more difficult, especially if the aetiology is unclear. Endomyocardial biopsy (EMB) is useful in establishing a histopathologic diagnosis for infiltrative and other cardiomyopathies for which a histopathologic diagnosis can influence therapy.4 Herein, we report a patient with cardiomyopathyof unknownetiologyundergoingelectrical stormablation and performing fluoroscopy-guided EMB.