Vaidya Vaibhav R, Abudan Anas A, Vasudevan Krithika, Shantha Ghanshyam, Cooper Leslie T, Kapa Suraj, Noseworthy Peter A, Cha Yong-Mei, Asirvatham Samuel J, Deshmukh Abhishek J
Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55906, USA.
Division of Cardiovascular Diseases, University of Iowa, Iowa, IA, USA.
J Interv Card Electrophysiol. 2018 Oct;53(1):63-71. doi: 10.1007/s10840-018-0410-7. Epub 2018 Jul 12.
Electroanatomic mapping (EAM) has been utilized as a modality to improve the sensitivity of endomyocardial biopsy (EMB). We sought to systematically review published medical literature on the efficacy and safety of EAM-guided EMB.
We searched Ovid MEDLINE, Ovid Embase, Ovid CDR, Cochrane Central, Scopus, and Web of Science for studies where EAM was used for EMB. Data abstracted included demographics, indications, final diagnoses, histology findings, and technical details of biopsy extraction. Test characteristics including sensitivity (Se), specificity (Sp), and area under curve (AUC) were calculated on a per-patient and per-biopsy level.
Seventeen studies (9 case series, 8 case reports) were included in this systematic review. EAM-guided EMB was performed in 148 patients and results of 207 individual biopsies were available for analysis. The most common indications for EAM-guided EMB were suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), myocarditis, and cardiac sarcoidosis (CS). The pooled sensitivity and specificity for EAM-guided EMB for the diagnosis of cardiomyopathies (ARVC, myocarditis, CS, and other specific diagnoses) were 92 and 58% on per-biopsy analysis and 100 and 39% on per-patient analysis. Among the individual components of abnormal EGMs, abnormal unipolar EGM had the best AUC on per-biopsy (0.81, 95% CI 0.68-0.90) and per-patient analysis (0.84, 95% CI 0.68-0.92). EAM-guided EMB appears safe. Adverse events included 1 hemopericardium, 2 minimal asymptomatic pericardial effusions, and 1 femoral hematoma.
EAM-guided EMB is a safe and efficacious method and might improve test characteristics over conventional fluoroscopy-guided biopsy.
心内电生理标测（EAM）已被用作一种提高心内膜心肌活检（EMB）敏感性的方法。我们试图系统回顾已发表的关于EAM引导下EMB的有效性和安全性的医学文献。
我们检索了Ovid MEDLINE、Ovid Embase、Ovid CDR、Cochrane Central、Scopus和Web of Science等数据库，以查找使用EAM进行EMB的研究。提取的数据包括人口统计学、适应证、最终诊断、组织学结果以及活检取材的技术细节。在每位患者和每次活检水平上计算包括敏感性（Se）、特异性（Sp）和曲线下面积（AUC）在内的检验特征。
本系统评价纳入了17项研究（9项病例系列研究，8项病例报告）。148例患者接受了EAM引导下的EMB，207次个体活检结果可供分析。EAM引导下EMB最常见的适应证是疑似致心律失常性右室心肌病（ARVC）、心肌炎和心脏结节病（CS）。在每次活检分析中，EAM引导下EMB诊断心肌病（ARVC、心肌炎、CS和其他特定诊断）的合并敏感性和特异性分别为92%和58%，在每位患者分析中分别为100%和39%。在异常心内电图的各个组成部分中，异常单极心内电图在每次活检（0.81，95%CI 0.68 - 0.90）和每位患者分析（0.84，95%CI 0.68 - 0.92）中具有最佳的AUC。EAM引导下的EMB似乎是安全的。不良事件包括1例心包积血、2例少量无症状心包积液和1例股部血肿。
EAM引导下的EMB是一种安全有效的方法，与传统透视引导下的活检相比，可能改善检验特征。
