Transcoronary ethanol ventricular tachycardia ablation in the modern electrophysiology era

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Frédéric SacherW G Stevenson

Abstract

Radiofrequency catheter ablation for ventricular tachycardia (VT) may be unsuccessful when critical portions of the circuit cannot be interrupted with either endocardial or epicardial radiofrequency application. We sought to investigate whether transcoronary ethanol ablation (TCEA) can be used as a therapy for patients with VT who have failed medications and radiofrequency ablation in the modern era. Nine patients (7 men, 55 +/- 9 years old, left ventricular ejection fraction 23% +/- 8%, 2.2 +/- 0.8 failed VT ablations) with at least 1 unsuccessful attempt at radiofrequency catheter ablation for symptomatic VT at our institution between 2000 and May 2007 underwent TCEA. The majority of patients had an ischemic cardiomyopathy (67%), and all patients had VT due to scar-related reentry. In the 7 patients with VT involving a septal scar, a septal perforator artery was a suitable target in 5 patients, whereas in the remaining patients, a distal branch of the circumflex and the conus branch of the right coronary artery were targeted. In the 2 patients in whom VT involved an inferior scar, a branch of the posterior descending artery was targeted. Acute success was obtained in 56% of patients (89% for clinical targeted VT). During a me...Continue Reading

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