Catheter Ablation of Ventricular Tachycardia by Intramyocardial Injection of Ethanol in an Animal Model of Chronic Myocardial Infarction

Reek, Sven; Geller, J. Christoph; Schildhaus, Hans–Ulrich; Mahnkopf, Dirk; Mittag, Joerg; Klein, Helmut U.

doi:10.1046/j.1540-8167.2004.03409.x

Cited by 9 publications

(5 citation statements)

References 42 publications

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“…Additional restrictions of the technique involve areas with severe coronary artery disease – a condition that limits access to the target vessel in ischemic ventricular tachycardia. Direct intra-myocardial ethanol injection has been tested in animal models with success [34-37]. The efficacy and safety of this procedure may change significantly from patient to patient, and is also dependent on the clinical experience of the practitioner [28,32].…”

Section: Ventricular Tachycardia Ablation With Ethanolmentioning

confidence: 99%

Ethanol for the treatment of cardiac arrhythmias

Schürmann

Peñalver

Valderrábano

2015

Current Opinion in Cardiology

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Introduction Ethanol infusion was an early mode of ablative treatment for cardiac arrhythmias. Its initial descriptions involved coronary intra-arterial delivery, targeting arrhythmogenic substrates in drug-refractory ventricular tachycardia or the atrioventricular node. Largely superseded by radiofrequency ablation (RFA) and other contact-based technologies as a routine ablation strategy, intracoronary arterial ethanol infusion remains as an alternative option in the treatment of ventricular tachycardia when conventional ablation fails. Arrhythmic foci that are deep-seated in the myocardium may not be amenable to catheter ablation from either the endocardium or the epicardium by RFA, but they can be targeted by an ethanol infusion. Recent findings Recently, we have explored ethanol injection through cardiac venous systems, in order to avoid the risks of complications and limitations of coronary arterial instrumentation. Vein of Marshall ethanol infusion is being studied as an adjunctive procedure in ablation of atrial fibrillation, and coronary venous ethanol infusion for ventricular tachycardia. Conclusion Ethanol ablation remains useful as a bail-out technique for refractory cases to RFA, or as an adjunctive therapy that may improve the efficacy of catheter ablation procedures.

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Section: Ventricular Tachycardia Ablation With Ethanolmentioning

confidence: 99%

Ethanol for the treatment of cardiac arrhythmias

Schürmann

Peñalver

Valderrábano

2015

Current Opinion in Cardiology

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“…Kreidieh et al 23 used retrograde coronary venous ethanol ablation as a bail‐out approach to failed VT ablation, particularly from left ventricular summit. Meanwhile, transcatheter intra‐myocardial ethanol injection was tested in animal models 24–28 . However, so far this technique has not been reported in human beings and this special catheter has not been widely used clinically.…”

Section: Discussionmentioning

confidence: 99%

Surgical ablation supplemented by ethanol injection for ventricular tachycardia refractory to percutaneous ablation

Yang

Shao

et al. 2021

Cardiovasc electrophysiol

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Background A combination of endocardial and epicardial approaches has improved the overall success rate of ventricular tachycardia (VT) ablation in patients with cardiomyopathy. However, the origins of some VTs are truly intramural or close to coronary arteries, which makes this combined strategy either prone to failure or too risky. Objectives This observational study aimed to explore the feasibility and efficacy of direct epicardial ablation combined with intramural ethanol injection via surgical approach for inaccessible intramural VTs or VTs too close to coronary arteries. Methods In four canines ventricular lesions produced by direct epicardial injection of ethanol were assessed. Six consecutive patients with recurrent VT refractory to catheter endocardial and epicardial RF ablation and that remained inducible after surgical epicardial mapping and RF ablation were included. Ethanol was injected by needle at the epicardial RF ablation sites. The primary outcome was freedom of sustained VT determined by device interrogation and periodical 24‐h holter recordings subsequently. Results In an animal study, the lesions were homogenous and increased in size with the volume of ethanol injected. In all six patients, ethanol injection at the target sites in the anterior or lateral left ventricle abolished inducible VT. Over a median follow‐up of 22 months (range, 6–65), all patients remained free of sustained VT. One patient died of pulmonary infection one year after the procedure. Conclusions A hybrid strategy of surgical ablation combined with intramural ethanol injection is feasible and effective in patients with multiple failed percutaneous ablation attempts.

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“…By coincidence, the arrhythmogenic substrate was protected also from the epicardial side by calcifications, which made it inaccessible for conventional epicardial RF catheter ablation. For such cases, various alternative approaches have been introduced: (1) alcohol ablation of coronary vessel, 1 (2) coil embolization of coronary artery, 2 (3) bipolar RF ablation, 3 (4) stereotactic ablative radiosurgery, 4 and (5) intramural needle catheter ablation. 5 Each approach has its advantages and limitations.…”

Section: Discussionmentioning

confidence: 99%

“…For such scenarios, alternative methods have been introduced. 1 , 2 , 3 , 4 , 5 Aside from these techniques, we report a novel technique of modification of arrhythmogenic substrate. We also introduce a sensitive method for visualization of a concealed thrombus within the left ventricle by means of intracardiac echocardiography (ICE).…”

Section: Introductionmentioning

confidence: 99%