Targeted endomyocardial biopsy using electroanatomical voltage mapping in the early stage of arrhythmogenic right ventricular cardiomyopathy

Endomyocardial biopsy (EMB) is useful for making a diagnosis of cardiomyopathy. However, the sensitivity of conventional EMB specimens from the interventricular septum is low in arrhythmogenic right ventricular cardiomyopathy (ARVC), especially in the early stage, because of the limited location of the affected tissue. Therefore, it is important to be able to target only the affected tissue in order to improve the sensitivity of the EMB, especially in the early stage of ARVC. A significant correlation between the low voltage areas identified by the electroanatomical voltage mapping (EVM) and abnormal findings from the EMB in ARVC has been reported. We describe an innovative strategy for performing EMB, using EVM to identify the local affected area and to perform a selective EMB from that area.