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Endomyocardial Biopsy

Endomyocardial biopsy is an uncommon procedure in the catheterization laboratory and used mostly for monitoring of cardiac transplant rejection.

Indications, Contraindications, and Complications

Monitoring cardiac transplant rejection and determining anthracycline cardiotoxicity are the only two definitive indications for endomyocardial biopsy (Table 7-3). Other indications include making a diagnosis for secondary causes of cardiomyopathy, myocarditis (when there is a history of congestive heart failure in the past 6 months), and differentiation between restrictive and constrictive cardiomyopathies.

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Contraindications to endomyocardial biopsy are anticoagulation and anatomic abnormalities.

Complications of endomyocardial biopsy include the following:
  1.    Access site related (3%)
  2.    Biopsy related (3%)
  3.    Arrhythmia (1%)
  4.    Conduction abnormalities (1%)
  5.    Perforation (0.7%)
  6.    Death (0.4%)

Note: Complication rates are higher for patients with cardiomyopathy than for heart transplant …