Transcoronary ethanol ablation for ventricular tachycardia

Transcoronary ethanol ablation for ventricular tachycardia (VT)

Michifumi Tokuda, Piotr Sobieszczyk, Andrew C Eisenhauer, Pipin Kojodjojo, Keiichi Inada, Bruce A Koplan, Gregory F Michaud, Roy M John, Laurence M Epstein, William G Stevenson and Usha B Tedrow from Brigham and Women’s Hospital & Harvard Medical School, Boston along with Frédéric Sacher from Univ Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France [1] have published an update on transcoronary ethanol ablation for VT for recurrent ventricular tachycardia after failed radiofrequency catheter ablation. Transcoronary ethanol ablation (TCEA) for ventricular tachycardia is considered when endocardial and epicardial radiofrequency catheter ablation has failed, or when a deep intra myocardial origin is likely.

In their report, in twenty seven patients, of which fourteen had ischemic cardiomyopathy, TCEA was attempted. This was among 274 consecutive ventricular tachycardia patients taken for ablation in their centers. Eighteen of the twenty two patients in whom one to three arteries were targeted achieved non inducibility of ventricular tachycardia. Five of them developed complete heart block while three with advanced heart failure died within a month. Recurrence of ventricular tachycardia was noted in about two thirds of cases. But of the eleven patients with prior ventricular tachycardia (VT) storm, nine were free of VT storm. The technical limitations were inadequate target vessels and presence of collaterals. In seven of the eight patients with recurrences, a VT with a different QRS morphology originating from the same region was noted.

Reference

1. Michifumi Tokuda, Piotr Sobieszczyk, Andrew C Eisenhauer, Pipin Kojodjojo, Keiichi Inada, Bruce A Koplan, Gregory F Michaud, Roy M John, Laurence M Epstein, Frédéric Sacher, William G Stevenson, Usha B Tedrow. Circ Arrhythm Electrophysiol. 2011;4:889-96.