Ethanol for the treatment of cardiac arrhythmias

Abstract

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 Largely superseded by radiofrequency ablation (RFA) and other contact-based technologies as a routine ablation strategy, intracoronary arterial ethanol infusion remains as an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.

Management of refractory ventricular tachycardia by direct intramyocardial injection of alcohol: A novel method

“…Alcohol, when administered in high concentrations in tissues, dissolves the cell membrane and disrupts the tertiary protein structure, leading to immediate cell lysis. 7 This property explains the immediate termination of VT in our case. Many complications associated with TCEA and transvenous ethanol ablation can be overcome by direct myocardial injection of alcohol.…”

“…TCEA causes direct chemical injury to cells and ischemic damage to myocardium by causing intravascular thrombosis. 7 This approach can sometimes lead to unintended large myocardial infarct or unrelated injury owing to collaterals or leak of alcohol. In instances of reduced ventricular function, this large-area necrosis may lead to further deterioration in LV function.…”

Clinical efficacy of open‐irrigated electrode cooled with half‐normal saline for initially failed radiofrequency ablation of idiopathic outflow tract ventricular arrhythmias

“…Multiple alternative techniques to improve outcomes of ablation have been investigated, including prolonged, high‐power RFA, coronary arterial or venous ethanol injection, intramyocardial infusion‐needle catheter ablation, bipolar ablation, simultaneous biventricular ablation, use of external‐beam radiation therapy, cryoablation or endo‐epicardial ablation . However, most of these strategies need specialized techniques and equipment that may not be available in most of the standard EP laboratories .…”

RF-energised intracoronary guidewire to enhance bipolar ablation of the interventricular septum:in-silicofeasibility study

“…If the results of future pre-clinical studies reveal that complete stenosis occurs after using the RF-energised guidewire, pre-treatment angiographic mapping of the damaged zone would make it possible to assess if this risk is acceptable. In order to reduce the risks as far as possible, we consider that the RF-energised guidewire should be introduced into a venous rather than an arterial branch, as recently proposed for the ethanol injection [26]. The technical limitations could be related to the metallic guidewire sticking to the inner wall of the vessel, which has been observed in endovenous varicose vein RF-ablation [27].…”