title: Transcoronary ethanol ablation for recurrent ventricular tachycardia after failed catheter ablation: an update.
abstract: BACKGROUND
  Despite substantial progress, radiofrequency catheter ablation (RFCA) fails in some patients. After encouraging results with transcoronary ethanol ablation (TCEA), we began offering TCEA routinely when endocardial and epicardial RFCA failed or a deep intramural substrate was likely.
  
  
  RESULTS
  Among 274 consecutive patients who underwent 408 ventricular tachycardia (VT) ablation procedures, 27 patients (21 men; age, 63 ± 13 years; left ventricular ejection fraction, 30 ± 11%; ischemic cardiomyopathy, 14) had 29 TCEA procedures attempted. In 5 patients, TCEA was abandoned because of unfavorable anatomy. In 22 patients, a mean of 1.3 ± 0.6 arteries (range, 1-3 arteries) were targeted for TCEA. After ablation, the targeted VT was no longer inducible in 18 of 22 (82%) patients. Complete heart block occurred in 5 patients, and 3 patients with advanced heart failure died within 30 days of the procedure. After the last TCEA procedure, a VT recurred in 64% of patients, and overall, 32% of patients died. Of 11 patients with prior VT storm, 9 were free of VT storm. At repeat study in 8 patients who had a recurrence, 7 had a new QRS morphology of VT originating from the same general substrate region as the prior VT.
  
  
  CONCLUSIONS
  In patients with difficult-to-control VT in whom RFCA fails, TCEA prevents all VT recurrences in 36% and improves arrhythmia control in an additional 27%. Inadequate target vessels, collaterals, and recurrence of modified VTs limit efficacy, but TCEA continues to play an important role for difficult VTs in these high-risk patients.
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. tokudam@gmail.com
authors: Michifumi
authors: M
authors: Tokuda
authors: Piotr
authors: P
authors: Sobieszczyk
authors: Andrew C
authors: AC
authors: Eisenhauer
authors: Pipin
authors: P
authors: Kojodjojo
authors: Keiichi
authors: K
authors: Inada
authors: Bruce A
authors: BA
authors: Koplan
authors: Gregory F
authors: GF
authors: Michaud
authors: Roy M
authors: RM
authors: John
authors: Laurence M
authors: LM
authors: Epstein
authors: Frédéric
authors: F
authors: Sacher
authors: William G
authors: WG
authors: Stevenson
authors: Usha B
authors: UB
authors: Tedrow
mesh_terms: D000368:Aged; D001900:Boston; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D006327:Heart Block / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000431:Ethanol