Transcoronary Ethanol Ablation For Ventricular Tachycardia

RRadiofrequency catheter ablation is a well established modality of treatment for ventricular tachycardia (VT). But it may not be successful in certain cases when the re-entrant circuit is situated deep within the myocardium and inaccessible to both endocardial and epicardial ablation. One of the earliest reports on transcoronary ethanol ablation of refractory ventricular tachycardia was by Inoue H et al in 1987 [1] in experimental animals followed by Brugada P et al in humans in 1989 [2]. Brugada P et al identified the artery supplying the arrhythmogenic area and injected 1.5-6ml of sterile 96% ethanol, which cured the arrhythmia in two of the three patients. In the third one, arrhythmia recurred when a new collateral blood supply developed to the arrhythmogenic region, which was successfully treated by a repeat procedure. They had done a careful transcoronary mapping with saline prior to ablation in all cases. One of their patients developed temporary complete atrioventricular block after high septal ethanol ablation, requiring pacemaker.