Electrogram guidance: A method to increase the precision and diagnosticyieldofendomyocardial biopsy for suspectedcardiac sarcoidosisand myocarditis.

Jackson J. Liang, Virginia B. Hebl, Christopher V. DeSimone, Malini Madhavan, Sudip Nanda, Suraj Kapa, Joseph J. Maleszewski, William D. Edwards, Guy Reeder, Leslie T. Cooper, Samuel J. Asirvatham

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


The aim of this study was to describe the method used to perform electrogram-guided EMB and correlateelectrogram characteristics with pathological and clinical outcomes. Background: Endomyocardial biopsy (EMB) is valuable in determining the underlying etiology of a cardiomyopathy. The sensitivity, however, for focal disorders, such as lymphocytic myocarditis and cardiac sarcoidosis (CS), is low. Thesensitivity of routine fluoroscopically guided EMB is low. Abnormal intracardiac electrograms are seen at sites ofmyocardial disease. However, the exact value of electrogram-guided EMB is unknown. Methods: We report 11 patients who underwent electrogram-guided EMB for evaluation of myocarditis and CS. Results: Of 40 total biopsy specimens taken from 11 patients, 19 had electrogram voltage<5 mV, all of which resulted in histopathologic abnormality (100% specificity and positive predictive value). A voltage amplitude cutoff value of 5 mV had substantially higher sensitivity (70% vs. 26%) and negative predictive value (62%) than 1.5 mV. Abnormal electrogram appearance at biopsy site had good sensitivity (67%) and specificity (92%) in predicting abnormal myocardium. Normal signals with voltage 5 mV signified normal myocardium with no significant diagnostic yield. Biopsy results guided therapy in all patients, including 5 with active myocarditis or CS, all of whom subsequently received immunosuppressive therapy. There were no procedural complications. Conclusions: In patients with suspected myocarditis or CS, electrogram-guided EMB targeting sites with abnormal orlow-amplitude electrograms may increase the diagnostic yield for detecting abnormal pathological findings.

Original languageEnglish (US)
Pages (from-to)466-473
Number of pages8
JournalJACC: Heart Failure
Issue number5
StatePublished - Oct 1 2014


  • Cardiac sarcoidosis
  • Cardiomyopathy
  • Electrogram
  • Endomyocardial biopsy
  • Myocarditis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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