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Case Reports
. 2012 Oct;9(10):1637-9.
doi: 10.1016/j.hrthm.2012.06.003. Epub 2012 Jun 6.

Coronary venous ethanol infusion for the treatment of refractory ventricular tachycardia

Alex Baher  1 , Dipan J Shah, Miguel Valderrabano
Affiliations
Case Reports

Coronary venous ethanol infusion for the treatment of refractory ventricular tachycardia

Alex Baher et al. Heart Rhythm. 2012 Oct.
No abstract available

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Figures

Figure 1
Figure 1
Coronary venous mapping and ethanol infusion in patient #1. A, Activation maps of VT in the AIV and in RV and LV cavities. The earliest activation site is shown coming from within the AIV. B, Selective venogram of the AIV showed two septal branches. C, The AIV was then cannulated with a decapolar catheter and the distal poles were inserted in the septal branch. Pacemaps were obtained that matched the QRS morphology of the clinical tachycardia as shown in F. D, The septal branch was cannulated with an angioplasty wire and occluded with a 1.5 × 6 mm balloon . Ethanol (98%, 1 cc) was then injected into the septal vein. E, CMR at baseline showed a preexisting mid myocardial septal area of delayed enhancement (Pre-ethanol), that was significantly expanded after ethanol injection. F, twelve-lead electrocardiogram of the spontaneous VT (left) and paced QRS from the septal banch of the AIV (right), along with automated calculation of percentage of similarity using Bard software (Bard Electrophysiology, Boston, MA).
Figure 2
Figure 2
Coronary venous mapping and ethanol infusion in patient #2. A through C, activation maps of the LV cavity, MCV and epicardial surface. The earliest LV site activates later than the MCV. The earliest sites in the epicardial surface are similar in timing to the MCV, but are spread over a larger area. D, MCV venogram showing multiple septal branches. E, cannulation of a septal branch with a quadripolar catheter. We selected the septal branch from which pacemaps matched best the clinical VT. F, wire cannulation of the targeted septal branch. G, angioplasty balloon cannulation and selective contrast injection of the targeted septal branch, in which ethanol (98%, 2 cc) was injected. H, clinical VT (top) and pacemap from the targeted septal branch, with percentages of similarity included.
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References

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