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There have repeatedly been reports of “almost healthy patients” who underwent endomyocardial biopsy—out of whatever considerations—and then died from cardiac tamponade with complications. The risk of a fatal event is 0.1% (1) to 0.03% (2), that of fatal cardiac tamponade is 0.42%. Certain disorders do not usually constitute an indication for myocardial biopsy—for example, atrial fibrillation without any indication of inflammatory cardiac disease, or moderate arrhythmias (extra systole in patient with unrestricted cardiac function), or re-entry tachycardia caused by an additional pathway, which is never of inflammatory origin. In case of suspected myocarditis with unrestricted cardiac functioning, myocardial biopsy is indicated as a measure of last resort only. The article remains too euphoric in its key messages because ultimately, only very few inflammations can be treated causally (for example, giant cell myocarditis); many forms of myocarditis heal spontaneously. Patients with uncharacteristic symptoms and moderate disorders should not undergo biopsy by default, since this exposes them to unnecessary risks and causes unnecessary expense. I would have wished for a more critical assessment of the method in a review article that is accessible to a wide range of doctors.

DOI: 10.3238/arztebl.2012.0757a

Dr. med. Mathias Brinschwitz
Facharzt für Innere Medizin, Marburg

privat@praxis-dr-brinschwitz.de

Conflict of interest statement
The author declares that no conflict of interest exists.

1.
Murphey JG, et al.: Endomyocardial biopsy in myocarditis Chapter 15. http://myocarditisfoundation.org/pdfs/From-Bench-to-Bedside-chapter-15.pdf
2.
Cooper LT: Endomyocardial biopsy. www.uptodate.com/contents/endomyocardial-biopsy?source=search_result&search=endomyocardial+biopsy&selectedTitle=1~9. Last accessed on 22.October 2012.
3.
Kühl U, Schultheiss HP: Myocarditis—elderly biopsy allows for tailored regenerative treatment. Dtsch Arztebl Int 2012; 109(20): 361–8. VOLLTEXT
1.Murphey JG, et al.: Endomyocardial biopsy in myocarditis Chapter 15. http://myocarditisfoundation.org/pdfs/From-Bench-to-Bedside-chapter-15.pdf
2.Cooper LT: Endomyocardial biopsy. www.uptodate.com/contents/endomyocardial-biopsy?source=search_result&search=endomyocardial+biopsy&selectedTitle=1~9. Last accessed on 22.October 2012.
3.Kühl U, Schultheiss HP: Myocarditis—elderly biopsy allows for tailored regenerative treatment. Dtsch Arztebl Int 2012; 109(20): 361–8. VOLLTEXT