on whether the correct site is biopsied. There is a risk that a diagnosis can be missed if the biopsy misses the diseased part of heart muscle, particularly with myocardial inflammation or fibrosis. An experienced pathologist trained in biopsy analysis and interpretation also reflects EMB’s reliability. Variability between pathologists has been observed. Complications A frequent concern regarding EMB has been its safety. However, it has a low risk of less than 1% when performed by an experienced physician in a specialist centre. Possible complications, which almost all occur at time of procedure, include rupture of the right intraventricular septum, conduction block, arrhythmias, pneumothorax, tricuspid regurgitation, atrioventricular fistula, and pulmonary embolism. Death has been reported, but is rare. History Early heart biopsies, sampling pericardium, in the latter half of the 1950s were performed through a cut in the left intercostal space at the costochondral junction. However this method risked lung and coronary blood vessel damage, cardiac tamponade and arrythmias. EMB, sampling myocardium, has evolved since it was first pioneered in Japan by S. Sakakibra and S. Konno in 1962. The concept of introducing a biopsy needle through the right internal or external jugular vein to reach the right intraventricular septum for the purpose of sampling the heart muscle was initiated in 1965 by R. T. Bulloch. In 1972, the bioptome and procedure was modified by Philip Caves. This was to allow access percutaneously. References Biopsy Cardiology Medical procedures