Epicardial and subselective transcoronary chemical ablation of incessant ventricular tachycardia.

Incessant ventricular tachycardia in patients with severely depressed ventricular function remains a major therapeutic challenge. Although alcohol ablation via the tachycardia related vessel has been shown to be an effective alternative, it might not be applicable in some cases due to anatomic limitations. In three patients with ischemic cardiomyopathy and incessant ventricular tachycardia no effective antiarrhythmic therapy could be found. Alcohol ablation was then attempted but the tachycardia related vessel could not be intubated. A subselective injection of alcohol into a more proximal segment of the coronary artery was then performed in two cases. In one patient as subselective injection was also not possible, the injection was performed epicardially after thoracotomy. Ablation was successful in all cases. In very selected cases of incessant ventricular tachycardia that have failed all other therapeutic interventions, alcohol ablation of the tachycardia can be performed using an epicardial or subselective transcoronary injection of alcohol.