title: Retrograde Coronary Venous Ethanol Infusion for Ablation of Refractory Ventricular Tachycardia.
abstract: Radiofrequency ablation (RFA) of ventricular tachycardia (VT) can fail because of inaccessibility to the VT substrate. Transarterial coronary ethanol ablation can be effective but entails arterial instrumentation risk. We hypothesized that retrograde coronary venous ethanol ablation can be an alternative bail-out approach to failed VT RFA.
  
  
  
  Out of 334 consecutive patients undergoing VT/premature ventricular contraction ablation, 7 patients underwent retrograde coronary venous ethanol ablation. Six out of 7 patients had failed RFA attempts (including epicardial in 3). Coronary venogram-guided venous mapping was performed using a 4F quadripolar catheter or an alligator-clip-connected angioplasty wire. Targeted veins included those with early presystolic potentials and pace-maps matching VT/premature ventricular contraction. An angioplasty balloon (1.5-2×6 mm) was used to deliver 1 to 4 cc of 98% ethanol into a septal branch of the anterior interventricular vein in 5 patients with left ventricular summit VT, a septal branch of the middle cardiac vein, and a posterolateral coronary vein (n=1 each). The clinical VT was successfully ablated acutely in all patients. There were no complications of retrograde coronary venous ethanol ablation, but 1 patient developed pericardial and pleural effusion attributed to pericardial instrumentation. On follow-up of 590±722 days, VT recurred in 4 out of 7 patients, 3 of whom were successfully reablated with RFA.
  
  
  
  Retrograde coronary venous ethanol ablation is safe and feasible as a bail-out approach to failed VT RFA, particularly those originating from the left ventricular summit.
authors.affiliation: Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
authors.forename: Bahij
authors.initials: B
authors.lastname: Kreidieh
authors.affiliation: Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez-Mañero
authors.affiliation: Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
authors.forename: Paul
authors.initials: P
authors.lastname: Schurmann
authors.affiliation: Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
authors.forename: Sergio Hugo
authors.initials: SH
authors.lastname: Ibarra-Cortez
authors.affiliation: Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
authors.forename: Amish S
authors.initials: AS
authors.lastname: Dave
authors.affiliation: Division of Cardiac Electrophysiology, Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
authors.forename: Miguel
authors.initials: M
authors.lastname: Valderrábano
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D017115:Catheter Ablation; D017023:Coronary Angiography; D003331:Coronary Vessels; D004562:Electrocardiography; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000431:Ethanol
keywords: LV summit; catheter ablation; ethanol; premature ventricular contractions; tachycardia, ventricular