Feasibility of Combined Unipolar and Bipolar Voltage Maps to Improve Sensitivity of Endomyocardial Biopsy

Michela Casella, Francesca Pizzamiglio, Antonio Dello Russo, Corrado Carbucicchio, Ghaliah Al-Mohani, Eleonora Russo, Pasquale Notarstefano, Maurizio Pieroni, Giulia D'Amati, Elena Sommariva, Marta Giovannardi, Andrea Carnevali, Stefania Riva, Gaetano Fassini, Fabrizio Tundo, Pasquale Santangeli, Luigi Di Biase, Leonardo Bolognese, Andrea Natale, Claudio Tondo

Research output: Contribution to journalArticlepeer-review


Background - Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases. Methods and Results - We performed endocardial bipolar EVM-guided EMBs in 29 patients and we analyzed unipolar EVM at withdrawal sites. Eighty myocardial samples were collected (mean, 2.8±0.9; median, 3 fragments per patient) and 60 were suitable for histological analysis. Ten specimens (17%) were collected from an area with discordant normal bipolar/low-voltage unipolar EVM and they were diagnostic or suggestive for arrhythmogenic right ventricular dysplasia/cardiomyopathy in 6 patients, for myocarditis and sarcoidosis in 1 patient each. Six samples (10%) were collected from an area with discordant low-voltage bipolar/normal unipolar EVM and they showed nonspecific features. The sensitivity of unipolar EVMs for a diagnostic biopsy finding EMB was significantly higher compared with bipolar EVMs analyzed according to samples (P

Original languageEnglish
Pages (from-to)625-632
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Issue number3
Publication statusPublished - Jun 4 2015


  • arrhythmogenic right ventricular dysplasia
  • myocarditis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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