Endomyocardial biopsy (EMB) has evolved from a single-indication test for the early diagnosis and monitoring of heart transplant rejection to the gold-standard technique to reach a definite and aetiological diagnosis in different cardiac disorders such as myocarditis and cardiomyopathies. It is currently considered a fundamental tool in the diagnostic workup of unexplained acute heart failure with haemodynamic compromise. For interventional cardiologists, EMB represents a unique opportunity to bridge invasive diagnostics with personalised care. By embracing technological advancements, integrating EMB with non-invasive modalities, the field advances towards more precise and effective management of complex cardiac conditions. However, safety remains a concern when performing EMB; indeed, although rare, major complications occur in about 1-5% of cases. Correct indication for the procedure and specific expertise to minimise the risk of complications are fundamental to obtain an acceptable risk/benefit profile. Therefore, this review examines the contemporary use of EMB from the perspective of interventional cardiologists to provide a practical resource for clinical practice and to better understand when and how to perform both right and left ventricular EMB in current practice.
