"Hybrid" Voltage-Guided Endomyocardial Biopsy Performed Concurrently With Electrophysiology Procedures.

Endomyocardial biopsy (EMB) remains essential for diagnosing inflammatory cardiomyopathy but is limited by patchy disease distribution and procedural burden. We describe a hybrid strategy integrating voltage-guided EMB into clinically indicated electrophysiology procedures. In 23 patients with PET-avid myocardial inflammation, hybrid voltage-guided EMB was feasible, safe, and frequently clinically impactful, with no major procedural complications. Biopsy findings directly influenced immunosuppression management in 83% of patients, including initiation, discontinuation, or intentional withholding of therapy. Incorporating targeted EMB into routine electrophysiology workflows may reduce the need for separate biopsy procedures and refine treatment decisions in suspected inflammatory cardiomyopathy.