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Review
. 2021 Apr 5;17(1):19-23.
doi: 10.14797/NECT9586. Epub 2021 Mar 25.

Alcohol Ablation for Ventricular Tachycardia

Adi Lador  1 , Akanibo Da-Wariboko  1 , Liliana Tavares  1 , Miguel Valderrábano  1
Affiliations
Review

Alcohol Ablation for Ventricular Tachycardia

Adi Lador et al. Methodist Debakey Cardiovasc J. .

Abstract

Catheter-based radiofrequency (RF) ablation is an effective, well-established therapy for ventricular tachycardia (VT). However, a large number of patients still have recurrences, particularly those with substrates arising from intramural locations that are inaccessible through endo- or epicardial catheter approaches. Several unconventional ablation techniques have been proposed to treat RF-refractory VT, including transarterial coronary ethanol ablation and retrograde coronary venous ethanol ablation. We review the evidence regarding the mechanisms, procedural aspects, and alcohol ablation outcomes for ventricular arrhythmias.

Keywords: LV summit; alcohol ablation; ventricular tachycardia.

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Conflict of interest statement

The authors have completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.

Figures

Figure 1.
Figure 1.
Venous mapping and ethanol ablation technique. (A) Coronary sinus venogram (left anterior oblique caudal projection) showing two septal branches at the take-off of the anterior interventricular vein (AIV). (B) Octapolar catheter in the first septal vein. Intramural vein signals precede QRS by 58 ms, and pace-mapping reproduces exact QRS morphology (inset). (C) 3-dimensional activation map shows early (red) signals in the AIV and the location of the octopolar catheter. (D) Balloon cannulation of the septal vein. (E) Intramural echogenicity after venous ethanol, which leads to elimination of ectopy (bottom). (F) Kaplan-Meier plot of ablation success over 1-year follow-up in 55 patients with previous failed radiofrequency ablations. CS: coronary sinus; LVOT: left ventricle outflow tract
Figure 2.
Figure 2.
Mapping and ethanol ablation of an infarct-related vein in ischemic ventricular tachycardia (VT). (A) Endocardial 3-dimensional bipolar voltage map of the left ventricle (LV) showing a dense (< 0.5 mV) scar, with a scar vein directly on its epicardial aspect. (B) Venography. (C) Octapolar catheter in the vein. (D) Localization of octapolar relative to scar. (E) Entrainment and mid-diastolic signals confirm participation in VT circuit. (F) Double balloon ethanol vein injection. (G) Transmural echogenicity in lateral LV after ethanol.
See this image and copyright information in PMC

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