Work

Endomyocardial biopsy after leadless pacemaker implantation in patient with suspected cardiac amyloidosis

Year: 2026

Type: article

Abstract: Leadless pacemakers (LPMs) are increasingly used especially in elderly patients; however, the safety of subsequent intracardiac procedures remains uncertain. We report a case of a 76-year-old man on maintenance hemodialysis with suspected cardiac amyloidosis who had previously undergone LPM implantation. Despite grade 3 uptake on technetium-99 m pyrophosphate scintigraphy, the presence of monoclonal protein and negative extracardiac biopsies necessitated endomyocardial biopsy (EMB) for definitive diagnosis. Preprocedural cardiac computed tomography demonstrated precise localization of the LPM near the right ventricular outflow tract. Based on these findings, EMB was safely performed via a femoral vein approach without device-related complications. Histopathology and gene test confirmed wild-type transthyretin amyloid cardiomyopathy. This case highlights the importance of individualized, imaging-guided procedural planning to safely perform EMB after LPM implantation. Learning objective: Endomyocardial biopsy remains essential for definitive diagnosis and amyloid typing in patients with suspected transthyretin amyloid cardiomyopathy who have concomitant monoclonal protein, even when bone scintigraphy is strongly positive. In patients with a previously implanted leadless pacemaker, preprocedural imaging to evaluate the spatial relationship between the device and the intended biopsy site is critical for procedural safety.

Source: Journal of Cardiology Cases

DOI: 10.1016/j.jccase.2026.07.004