Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;9(1):28-39.
doi: 10.1016/j.jacep.2022.08.035. Epub 2022 Oct 26.

Acute and Long-Term Scar Characterization of Venous Ethanol Ablation in the Left Ventricular Summit

Affiliations
Free article

Acute and Long-Term Scar Characterization of Venous Ethanol Ablation in the Left Ventricular Summit

Stephanie C Fuentes Rojas et al. JACC Clin Electrophysiol. 2023 Jan.
Free article

Abstract

Background: Venous ethanol ablation (VEA) can be effective for ventricular arrhythmias from the left ventricular summit (LVS); however, there are concerns about excessive ablation by VEA.

Objectives: The purpose of this study was to delineate and quantify the location, extent, and evolution of ablated tissue after VEA as an intramural ablation technique in the LVS.

Methods: VEA was performed in 59 patients with LVS ventricular arrhythmias. Targeted intramural veins were selected by electrograms from a 2F octapolar catheter or by guide-wire unipolar signals. Median ethanol delivered was 4 mL (IQR: 4-7 mL). Ablated areas were estimated intraprocedurally as increased echogenicity on intracardiac echocardiography (ICE) and incorporated into 3-dimensional maps. In 44 patients, late gadolinium enhancement cardiac magnetic resonance (CMR) imaged VEA scar and its evolution.

Results: ICE-demonstrated increased intramural echogenicity (median volume of 2 mL; IQR: 1.7-4.3) at the targeted region of the 3-dimensional maps. Post-ethanol CMR showed intramural scar of 2.5 mL (IQR: 2.1-3.5 mL). Early (within 48 hours after VEA) CMR showed microvascular obstruction (MVO) in 30 of 31 patients. Follow-up CMR after a median of 51 (IQR: 41-170) days showed evolution of MVO to scar. ICE echogenicity and CMR scar volumes correlated with each other and with ethanol volume. Ventricular function and interventricular septum remained intact.

Conclusions: VEA leads to intramural ablation that can be tracked intraprocedurally by ICE and creates regions of MVO that are chronically replaced by myocardial scar. VEA scar volume does not compromise septal integrity or ventricular function.

Keywords: ablation; cardiac magnetic resonance; ethanol; ventricular arrhythmias.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Supported by the Charles Burnett III and Lois and Carl Davis Centennial Chair endowments (Houston, Texas, USA) and National Institutes of Health/National Heart, Lung, and Blood Institute R01 HL115003 (Dr Valderrábano). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publication types

LinkOut - more resources