Right or left endomyocardial biopsy? A systematic review with meta-analysis about complications and safety

Endomyocardial biopsy (EMB) is an invasive procedure used to diagnose myocarditis and investigate other nonischaemic cardiomyopathies. However, it is still contentious whether right ventricle endomyocardial biopsy (RV-EMB) is safer than left ventricle endomyocardial biopsy (LV-EMB). Therefore, we aimed to perform an updated meta-analysis comparing the outcomes of LV-EMB vs RV-EMB in patients submitted to this procedure.

We searched PubMed, Embase, and Cochrane Central in January 2023 for studies comparing the outcomes of patients submitted to LV-EMB and/or RV-EMB. Outcomes were major and minor complications after the procedure: death, cardiac tamponade requiring pericardiocentesis, pericardial effusion without pericardiocentesis, stroke, transient ischemic attack, arrhythmias as permanent or transient atrioventricular block, atrial fibrillation, ventricular fibrillation, chest pain and local complications. Statistical analysis was performed using RevMan 5.1.7. Heterogeneity was assessed with I² statistics. The risk of bias of the studies has been evaluated with the ROBINS-I tool.

We included 6308 patients from 6 studies. The mean age was 49.8 years, with approximately 70% male patients. All studies were observational prospective or retrospective. Pericardial tamponade and/or pericardial effusion (odds ratio 0.54; 95% confidence interval 0.31-0.93; p = 0.03; I² = 20%) after the procedure were significantly lower in patients submitted to LV-EMB compared with RV-EMB.

In conclusion, a minor rate of pericardial perforation was observed during LV-EMB compared to RV-EMB. It was also observed that LV-EMB provides a high diagnostic yield in diagnosing myocarditis and other cardiomyopathies.

Endomyocardial biopsy (EMB) is an invasive procedure used to diagnose cardiac diseases. Our aim is to study which side of the heart is safer for this procedure.•Biopsy of left ventricle presented less perforation of the heart wall.•Some studies suggest a better diagnostic performance of the left ventricle biopsy.