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.