Liliana Tavares1, Adi Lador1, Stephanie Fuentes1, Akanibo Da-Wariboko1, Krzysztof Blaszyk2, Katarzyna Malaczynska-Rajpold2, Giorgi Papiashvili3, Sergey Korolev4, Petr Peichl5, Josef Kautzner5, Matthew Webber6, Darren Hooks6, Moisés Rodríguez-Mañero7, Darío Di Toro8, Carlos Labadet8, Takeshi Sasaki9, Kaoru Okishige10, Apoor Patel1, Paul A Schurmann1, Amish S Dave1, Tapan G Rami1, Miguel Valderrábano11. 1. Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA. 2. Poznan University of Medical Sciences, Poznan, Poland. 3. Arrhythmia Unit, Jo Ann Medical Center, Tbilisi, Georgia, USA. 4. Federal Research and Clinical Center of the FMBA of Russia, Moscow, Russia. 5. Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic. 6. Wellington Hospital, Wellington, New Zealand. 7. Arrhythmia Unit, Complexo Hospitalario de Santiago de Compostela, A Coruña, Spain. 8. Hospital CEMIC, Buenos Aires, Argentina. 9. Heart Rhythm Center, National Hospital Organization Disaster Medical Center, Tokyo, Japan. 10. Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan. 11. Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA. Electronic address: mvalderrabano@houstonmethodist.org.
Abstract
OBJECTIVES: The aim of this study was to assess the long-term efficacy and outcomes of retrograde venous ethanol ablation in treating ventricular arrhythmias (VAs). BACKGROUND: Retrograde coronary venous ethanol ablation (RCVEA) can be effective for radiofrequency ablation (RFA)-refractory VAs, particularly those arising in the LV summit (LVS). METHODS: Patients with drug and RFA-refractory VAs were considered for RCVEA after RF failure attempts. Intramural coronary veins (tributaries of the great cardiac, anterior interventricular, lateral cardiac, posterolateral, and middle cardiac) were mapped using an angioplasty wire. Ethanol infusion was delivered in veins with appropriate signals. RESULTS: Of 63 patients (age 63 ± 14 years; 60% men) with VAs (71% extrasystole, 29% ventricular tachycardia, 76% LVS origin), RCVEA was performed in 56 patients who had suitable vein branches. These were defined as those amenable to cannulation and with intramural signals that preceded those mapped in the epicardium or endocardium and had better matching pace maps or entrainment responses. Seven patients had no suitable veins and underwent RFA. In 38 of 56 (68%) patients, the VAs were successfully terminated exclusively with ethanol infusion. In 17 of 56 (30%) patients, successful ablation was achieved using ethanol with adjunctive RFA in the vicinity of the infused vein due to acute recurrence or ethanol-induced change in VA morphology. Overall, isolated or adjuvant RCVEA was successful in 55 of 56 (98%) patients. At 1-year follow-up, 77% of patients were free of recurrent arrhythmias. Procedural complications included 2 venous dissections that led to pericardial effusions. CONCLUSIONS: RCVEA offers a significant long-term effective treatment for patients with drug and RF-refractory VAs.
OBJECTIVES: The aim of this study was to assess the long-term efficacy and outcomes of retrograde venous ethanol ablation in treating ventricular arrhythmias (VAs). BACKGROUND: Retrograde coronary venous ethanol ablation (RCVEA) can be effective for radiofrequency ablation (RFA)-refractory VAs, particularly those arising in the LV summit (LVS). METHODS: Patients with drug and RFA-refractory VAs were considered for RCVEA after RF failure attempts. Intramural coronary veins (tributaries of the great cardiac, anterior interventricular, lateral cardiac, posterolateral, and middle cardiac) were mapped using an angioplasty wire. Ethanol infusion was delivered in veins with appropriate signals. RESULTS: Of 63 patients (age 63 ± 14 years; 60% men) with VAs (71% extrasystole, 29% ventricular tachycardia, 76% LVS origin), RCVEA was performed in 56 patients who had suitable vein branches. These were defined as those amenable to cannulation and with intramural signals that preceded those mapped in the epicardium or endocardium and had better matching pace maps or entrainment responses. Seven patients had no suitable veins and underwent RFA. In 38 of 56 (68%) patients, the VAs were successfully terminated exclusively with ethanol infusion. In 17 of 56 (30%) patients, successful ablation was achieved using ethanol with adjunctive RFA in the vicinity of the infused vein due to acute recurrence or ethanol-induced change in VA morphology. Overall, isolated or adjuvant RCVEA was successful in 55 of 56 (98%) patients. At 1-year follow-up, 77% of patients were free of recurrent arrhythmias. Procedural complications included 2 venous dissections that led to pericardial effusions. CONCLUSIONS: RCVEA offers a significant long-term effective treatment for patients with drug and RF-refractory VAs.
Authors: Apoor Patel; Michelle Nsahlai; Thomas Flautt; Akanibo Da-Warikobo; Adi Lador; Carlos Tapias; Diego Rodríguez; Luis Carlos Sáenz; Paul A Schurmann; Amish Dave; Miguel Valderrábano Journal: Circ Arrhythm Electrophysiol Date: 2022-08-02