Fig. 3.

Electroanatomic mapping (EAM)-guided endomyocardial biopsy (EMB) in a patient with suspected cardiac sarcoidosis. A Bipolar EAM by CARTO3® system and high density mapping PentaRay® (black arrow, Biosense Webster®) of the right side of the interventricular septum (IVS), where healthy myocardium with a signal > 1.5 mV is depicted in violet. Focal pathologic areas with decreased voltages are found in the middle of the IVS (** green–blue signal < 1.5 mV). Modified biopsy forceps (Cordis®—white arrow) are visualized in the map and can identify the precise point where performing EMB. B Fluoroscopic visualization (anteroposterior view) of the mapping catheter (black arrow) and biopsy forceps. ## Atrial pacing wire and § ventricular pacing wire in a patient with a permanent pacemaker. C Fluorodeoxyglucose positron emission tomography (FDG-PET) of the same patient shows a focal lesion in the middle of IVS suspected of granuloma. FDG-PET showed also several pulmonary lesions consistent with sarcoidosis. The patient presented a year before with a complete atrioventricular block. LV indicates left ventricle; IVS, interventricular septum; PA indicates pulmonary artery; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract