Need an endomyocardial biopsy? Call your electrophysiology team

Abstract Introduction With significant advances in targeted chemotherapeutic options for soft tissue tumours, obtaining a tissue diagnosis is more important than ever. Primary and secondary cardiac tumours are rare [1] and endomyocardial biopsy of these tumours has been sparsely reported [2-9]. Advanced tools in cardiac electrophysiology happen to lend themselves well to cardiac tumour biopsy. Our electrophysiology (EP) guided endomyocardial biopsy (EMB) service includes electrophysiologists, cardio-oncology specialists, cardiac imaging specialists, oncologists, and pathologists. For the last 9 years all targeted endomyocardial biopsies in our tertiary institution have been undertaken by our EP guided EMB service with extensive experience in electroanatomical mapping (EAM), visualisable sheaths and integrated intracardiac echography (ICE). We report the findings. Methods We performed a retrospective review of all cases referred to the EP guided endomyocardial biopsy service at our centre and identified those with attempts to biopsy a cardiac mass. We describe the incorporation of advanced electrophysiology techniques utilised by the service. Specifically, the use of intracardiac echocardiography integrated into an electro-anatomical mapping system and bioptome delivery via a visualisable, deflectable sheath. This allows for the real time 3D visualisation of the target mass, surrounding anatomy and position of the bioptome during biopsy. Results Of 38 patients who underwent targeted biopsy at our centre, a total of 8 patients (5 female; mean ± SD age 54 ± 21 years) were referred for cardiac tumour biopsy, undergoing a total of 9 procedures (mean ± SD duration 116 ± 21 mins). Table 1 details the patient’s pertinent history and underlying pathology, the tumour site, possible alternative biopsy sites, a summary of techniques and technologies utilised and the eventual diagnosis. In 100% of cases, tissue was sampled from the desired location, though in two patients the histological result was inconclusive due the retrieval of necrotic tissue or fibrotic tissue only. This translated into a definitive histopathological diagnosis in 75% of patients. One patient experienced a transient right bundle branch block during the procedure, in all others the procedures were uncomplicated. Image 1 exemplifies some of the cases with pre-procedure imaging results and intra-procedural views from both ICE and the EAM. Conclusion In this study, our approach to utilising the combination of intracardiac echocardiography integrated into an electro-anatomical mapping system and bioptome delivery via a visualisable, deflectable sheath appears safe, and provides unparalleled accuracy in endomyocardial sampling of cardiac tumours.Table 1Image 1