EMB

Q; Which side of the Endomyocardial biopsy (EMB) has a higher risk of complications? - select one

A) Right ventricle (RV)

B) Left Ventricle (LV) 

C) Similar risk

Answer: C

Although Biventricular EMB biopsy provides a much higher incremental diagnostic yield, RV EMB is mainly performed via the internal jugular of the femoral vein due to presumed safety reasons and ease. In some cases, such as suspected cardiac sarcoidosis or myocarditis with primary LV involvement, LV-EMB is performed. 

Interestingly, biopsy in the region of late gadolinium enhancement on CV-MRI does not increase the diagnosis yield. Complication rates are usually similar for LV and RV biopsy.

#procedures

#cardiolgy

References:

1. Cooper LT Jr. Right from the heart: when should myocardial biopsy be performed for suspected arrhythmogenic right ventricular cardiomyopathy/dysplasia? Eur Heart J 2008; 29:2705.

2. Cooper LT Jr. Role of left ventricular biopsy in the management of heart disease. Circulation 2013; 128:1492.

3. Yilmaz A, Kindermann I, Kindermann M, et al. Comparative evaluation of left and right ventricular endomyocardial biopsy: differences in complication rate and diagnostic performance. Circulation 2010; 122:900.

4. Seferović PM, Tsutsui H, McNamara DM, et al. Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy. Eur J Heart Fail 2021; 23:854.