Transcoronary ethanol ventricular tachycardia ablation in the modern electrophysiology era.

BACKGROUND: Radiofrequency catheter ablation for ventricular tachycardia (VT) may be unsuccessful when critical portions of the circuit cannot be interrupted with either endocardial or epicardial radiofrequency application.
OBJECTIVE: We sought to investigate whether transcoronary ethanol ablation (TCEA) can be used as a therapy for patients with VT who have failed medications and radiofrequency ablation in the modern era.
METHODS: Nine patients (7 men, 55 +/- 9 years old, left ventricular ejection fraction 23% +/- 8%, 2.2 +/- 0.8 failed VT ablations) with at least 1 unsuccessful attempt at radiofrequency catheter ablation for symptomatic VT at our institution between 2000 and May 2007 underwent TCEA. The majority of patients had an ischemic cardiomyopathy (67%), and all patients had VT due to scar-related reentry. In the 7 patients with VT involving a septal scar, a septal perforator artery was a suitable target in 5 patients, whereas in the remaining patients, a distal branch of the circumflex and the conus branch of the right coronary artery were targeted. In the 2 patients in whom VT involved an inferior scar, a branch of the posterior descending artery was targeted.
RESULTS: Acute success was obtained in 56% of patients (89% for clinical targeted VT). During a mean follow-up of 29 +/- 23 months, 3 deaths occurred and 67% of the patients were free of recurrence.
CONCLUSION: TCEA may represent an option in patients with refractory VT in whom radiofrequency ablation fails, especially in cases of septal scar in which failure is thought to be caused by inability to provide adequate lesion depth.