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Peer-reviewedCC BY-NC-ND 4.0Journal of Cardiology Cases

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

  • Naoto Kuyama1
  • Yasuhiro Izumiya1
  • Akihisa Tabira1
  • Yosuke Matsumoto1
  • Kyoko Hirakawa1
  • Naoki Nakayama1
  • Shinsuke Hanatani1
  • Hiroki Usuku1
  • Masafumi Kidoh2
  • Seitaro Oda2
  • Yasushi Matsuzawa1
  • Eiichiro Yamamoto1
2 more authors
  • Mitsuharu Ueda3
  • Kenichi Tsujita1
  1. 1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
  2. 2Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
  3. 3Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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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.

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Cite

BibTeXRIS
BibTeX
@article{kuyama2026endomyocardial,
  title = {{Endomyocardial biopsy after leadless pacemaker implantation in patient with suspected cardiac amyloidosis}},
  author = {Naoto Kuyama and Yasuhiro Izumiya and Akihisa Tabira and Yosuke Matsumoto and Kyoko Hirakawa and Naoki Nakayama and Shinsuke Hanatani and Hiroki Usuku and Masafumi Kidoh and Seitaro Oda and Yasushi Matsuzawa and Eiichiro Yamamoto and Mitsuharu Ueda and Kenichi Tsujita},
  journal = {Journal of Cardiology Cases},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jccase.2026.07.004},
  url = {https://doi.org/10.1016/j.jccase.2026.07.004},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Endomyocardial biopsy after leadless pacemaker implantation in patient with suspected cardiac amyloidosis
AU  - Naoto Kuyama
AU  - Yasuhiro Izumiya
AU  - Akihisa Tabira
AU  - Yosuke Matsumoto
AU  - Kyoko Hirakawa
AU  - Naoki Nakayama
AU  - Shinsuke Hanatani
AU  - Hiroki Usuku
AU  - Masafumi Kidoh
AU  - Seitaro Oda
AU  - Yasushi Matsuzawa
AU  - Eiichiro Yamamoto
AU  - Mitsuharu Ueda
AU  - Kenichi Tsujita
PY  - 2026
DA  - 2026/08/04
JO  - Journal of Cardiology Cases
DO  - 10.1016/j.jccase.2026.07.004
UR  - https://doi.org/10.1016/j.jccase.2026.07.004
AB  - 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.
SN  - 1878-5409
ER  -