Chapter 9: Endomyocardial Biopsy

Endomyocardial biopsy (EMB) is a useful diagnostic tool for the investigation and treatment of myocardial diseases. An extensive use of EMBs is impossible because this technique is invariably characterized by a mild, but not negligible, rate of major complications (around 1%) even when performed by experienced operators. For these reasons, it is fundamental a correct selection of patients to undergo EMB. In addition to some particular clinical contexts (after heart transplantation or for specific myocardial diseases), the most frequent indication for EMB is the in-depth evaluation of high-risk major clinical syndromes not responding to standard optimized medical therapy in the short term (recent-onset heart failure with relevant left ventricular dysfunction, sustained ventricular arrhythmias). Furthermore, the in-depth characterization of the myocardial substrate with immunohistochemical and biomolecular PCR (polymerase chain reaction) analyses can provide the guide for a biopsy-driven therapeutic plan.