Robotically Guided Left Ventricular Biopsy to Diagnose Cardiac Sarcoidosis
A Multidisciplinary Innovation Leading to First-in-Human Case
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Sarcoidosis may affect the heart in ≤25% of patients with known involvement of other organs.1 Because of the patchy and unpredictable nature of the infiltrate location, traditional endomyocardial biopsy of the right ventricular septum lacks sensitivity, and imaging and electroanatomic mapping (EAM) guidance can increase sensitivity.2,3 Involved areas may be difficult to reach with standard bioptome. We present a case using robotic assistance to overcome such limitation.
A 44-year-old healthy white female presented with syncope and dyspnea on exertion. Her electrocardiogram showed complete atrioventricular block with ventricular escape rhythm. Echocardiogram was normal, but cardiac magnetic resonance showed hypokinesis and hyperenhancement post-gadolinium in the basal anterior septum, right ventricle free wall, and mid anterolateral left ventricular (LV) wall suspicious for infiltrative cardiomyopathy. An electrophysiological study was performed showing inducible monomorphic ventricular tachycardia (VT) leading to a defibrillator placement. Standard biopsy, angiogram, and contrast chest computed tomography were noncontributory. She represented within 2 weeks with multiple defibrillator shocks because of multiple VT episodes, failed amiodarone, and hence an ablation was planned. Empirical …