Endoscopic ultrasound–guided fine-needle biopsy (EUS-FNB) is a minimally invasive procedure commonly used for diagnostic purposes. Because of the accuracy and safety of EUS, both intraluminal and extraluminal lesions can be sampled. Traditional methods of cardiac biopsy, typically through an endovascular approach, are well established. However, few EUS-guided cardiac interventions have been published,1-3 as they are rarely performed. Potential risks for cardiac biopsy, regardless of modality, include hemorrhage, perforation, arrhythmia, and valvular damage.