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

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.