{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T02:36:22Z","timestamp":1790562982785,"version":"4.1.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,10,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Endomyocardial biopsy (EMB) is part of 2010 Task Force Criteria (TFC) for arrhythmogenic right ventricular cardiomyopathy (ARVC). However, its usage has been curtailed because of its low presumed diagnostic yield, and it is now a poorly used tool. This study aims to analyze the contribution of EMB to the final diagnosis of ARVC.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We included 104 consecutive patients evaluated for a suspicion of ARVC, who were referred for EMB. Patients with suspected left dominant pattern were excluded from the primary analysis. Subjects were initially stratified according to TFC without considering EMB. After EMB, patients were reclassified accordingly, and the reclassification rate was calculated. EMB yielded a diagnostic finding in 92 patients (85.5%). After including EMB evaluation, 20 (43%) more patients \u201cat risk\u201d received a definite diagnosis of ARVC. Overall, 59 patients received a definite diagnosis of ARVC, 34% only after EMB. EMB appeared to be the better\u2010performing exam with respect to the final diagnosis (\u03b2, 2.2; area uder the curve, 0.73;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05). The reclassification improvement after EMB measured 28%. TFC score increased from 3.5\u00b11.3 to 4.3\u00b11.4 (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Notably, active inflammation was present in 6 (10%) patients. Minor complications were reported in only 2% of the cohort. In patients with suspected left\u2010dominant disease, conventional TFC performed poorly.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Electroanatomic voltage mapping\u2013guided EMB was safe and yielded an optimal diagnostic yield. It allowed upgrading of the diagnosis of nearly one\u2010third of the patients considered \u201cat risk.\u201d Classical TFC without EMB performed poorly in patients with the left dominant form of ARVC.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.021370","type":"journal-article","created":{"date-parts":[[2021,9,25]],"date-time":"2021-09-25T14:39:31Z","timestamp":1632580771000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Endomyocardial Biopsy: The Forgotten Piece in the Arrhythmogenic Cardiomyopathy Puzzle"],"prefix":"10.1161","volume":"10","author":[{"given":"Michela","family":"Casella","sequence":"first","affiliation":[{"name":"Cardiology and Arrhythmology Clinic University Hospital \u201cUmberto I \u2013Lancisi \u2013 Salesi\u201dMarche Polytechnic University Ancona Italy"},{"name":"Department of Clinical, Special and Dental Sciences University Hospital \u201cUmberto I \u2013Lancisi \u2013 Salesi\u201dMarche Polytechnic University Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9864-1938","authenticated-orcid":false,"given":"Marco","family":"Bergonti","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Dello Russo","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic University Hospital \u201cUmberto I \u2013Lancisi \u2013 Salesi\u201dMarche Polytechnic University Ancona Italy"},{"name":"Department of Biomedical Sciences and Public Health University Hospital \u201cUmberto I \u2013Lancisi \u2013 Salesi\u201dMarche Polytechnic University Ancona 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Polytechnic University Ancona Italy"},{"name":"Department of Biomedical Sciences and Public Health University Hospital \u201cUmberto I \u2013Lancisi \u2013 Salesi\u201dMarche Polytechnic University Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2589-6283","authenticated-orcid":false,"given":"Valentina","family":"Catto","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3947-7781","authenticated-orcid":false,"given":"Filippo","family":"Trombara","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano 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Radiology University Hospital \u201cUmberto I \u2013Lancisi \u2013 Salesi\u201d Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2172-4051","authenticated-orcid":false,"given":"Elena","family":"Sommariva","sequence":"additional","affiliation":[{"name":"Unit of Vascular Biology and Regenerative Medicine Monzino Cardiology CenterIRCCS Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8575-1748","authenticated-orcid":false,"given":"Stefania","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Cardiovascular Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera\u2010University of Padua Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9528-4883","authenticated-orcid":false,"given":"Monica","family":"De 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