Feasibility and Safety of a Three‐Dimensional Sheath for Right Ventricular Septal Endomyocardial Biopsy

Background Endomyocardial biopsy (EMB) is a complementary invasive procedure for the diagnosis of several cardiac diseases. New technical developments are needed to increase the safety of the procedure even in low‐volume centers. Methods We retrospectively enrolled patients who underwent EMB in our institution, which is a non‐heart transplant tertiary care center. Patients were divided into two groups according to the use of a standard long sheath (S‐T) or a three‐dimensional sheath (3D‐T). The latter was originally designed for conduction system pacing. Results There were 30 patients in the S‐T group and 16 in the 3D‐T group. Patients in the 3D‐T group were older (65 ± 19 vs. 52 ± 20, p = 0.049) and more likely to have ischaemic heart disease (25% vs. 0%, p = 0.011). Indications for EMB were similar in both groups except for a higher proportion of amyloidosis in the 3D‐T group (56% vs. 17%, p = 0.005). The total number of collected samples (10 ± 2 vs. 11 ± 3), their dimensions (1.3 ± 0.6 mm x 1 ± 0.3 mm vs. 1.7 ± 0.6 mm x 1.2 ± 0.4 mm) and the proportion of specimens meeting the quality standard to be analyzed (76% ± 26% vs. 83% ± 25%) didn't differ between 3D‐T and S‐T (all p = ns). Pericardial effusion or cardiac tamponade was more frequent in the S‐T group compared to the 3D‐T group (23% vs. 0%, p = 0.078). There were five cardiac tamponades in the S‐T group and none in the 3D‐T group. Conclusion The use of a 3D sheath for EMB of the right ventricular septum was feasible and safe with similar diagnostic accuracy compared to the standard long sheath technique.