Accurate Diagnosis of Clinically Isolated Cardiac Sarcoidosis Using a Novel Unipolar Mapping Guided Endomyocardial Biopsy Technique

Figures

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  Visual Summary. Electroanatomic Map Demonstrating Scar Localization and Biopsy Site in the Right Ventricle IVC = inferior vena cava; RA = right atrium; RV = right ventricle; SVC = superior vena cava.

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  Figure 1. Initial Electrocardiogram Shows Sinus Rhythm With Right Bundle Branch Block, Epsilon Waves, and T-Wave Inversions on the Precordial Leads (V1 to V3)

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  Figure 2. Cardiac Magnetic Resonance Images Demonstrating LGE (A) Short-axis view with diffuse late gadolinium enhancement (LGE) of the RV and anterior, septal, and inferior segments of the LV. (B) Two-chamber view with LGE in basal to mid anterior and inferior segments. (C) Four-chamber view with LGE in segments of the RV and mid inferoseptal segment of the LV. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.

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  Figure 3. Electroanatomic Mapping–Guided Endomyocardial Biopsy Endocardial bipolar mapping of the RV was created with an HD-grid high-resolution mapping catheter. The local voltage <1.5 mV was defined as the scar zone (gray area). The biopsy tissue was obtained from the scar border (white dot). The green dot represents His potential. RVOT = right ventricular outflow tract. Other abbreviations as in Figure 2.

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  Figure 4. Endomyocardial Biopsy From Interventricular Septum of the Right Ventricle Myocardium with aggregates of epithelioid histiocytes and multinucleated giant cells (arrow) (nonnecrotizing granulomas).

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  Figure 5. Fluorodeoxyglucose Positron Emission Tomography Shows Patchy Diffuse Uptake Involving Most of the Myocardium Including the RV and LV (A) Four-chamber view, and (B) short-axis view. Abbreviations as in Figure 2.