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Retrograde venous ethanol ablation for ventricular tachycardia

  • Liliana Tavares
    Affiliations
    Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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  • Miguel Valderrábano
    Correspondence
    Address reprint requests and correspondence: Dr Miguel Valderrábano, Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist Hospital, 6550 Fannin St, Suite 1901, Houston, TX 77030.
    Affiliations
    Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
    Search for articles by this author
Published:September 18, 2018DOI:https://doi.org/10.1016/j.hrthm.2018.09.010
      Radiofrequency catheter ablation (RFCA) has been considered the first-line therapy for treatment of drug-refractory ventricular arrhythmias (VAs).
      • Pedersen C.T.
      • Kay G.N.
      • Kalman J.
      • et al.
      EHRA/HRS/APHRS expert consensus on ventricular arrhythmias.
      The success of catheter ablation depends on our ability to reach the anatomic location of the ventricular tachycardia (VT) substrate. VTs arising from deep intramural regions
      • Baher A.
      • Shah D.J.
      • Valderrabano M.
      Coronary venous ethanol infusion for the treatment of refractory ventricular tachycardia.
      or in close proximity to coronary vessels
      • Lin C.Y.
      • Chung F.P.
      • Lin Y.J.
      • et al.
      Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: electrocardiographic characteristics and correlative anatomy.
      can have limited RFCA success. Transarterial coronary ethanol ablation has been used as an alternative treatment option and is reasonably successful in treating RFCA-refractory VTs.
      • Schurmann P.
      • Penalver J.
      • Valderrabano M.
      Ethanol for the treatment of cardiac arrhythmias.
      However, it is limited by technical difficulties and potential complications inherent to coronary arterial instrumentation, such as coronary artery dissection and unintended collateral damage in incomplete balloon seals. Other complications include complete atrioventricular block and pericarditis.
      • Schurmann P.
      • Penalver J.
      • Valderrabano M.
      Ethanol for the treatment of cardiac arrhythmias.
      Retrograde coronary venous ethanol ablation (RCVEA) has been described as an alternative treatment to the arterial approach. RCVEA overcomes some of the limitations associated with transarterial coronary ethanol ablation and avoids instrumentation of the coronary arteries.

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      References

        • Pedersen C.T.
        • Kay G.N.
        • Kalman J.
        • et al.
        EHRA/HRS/APHRS expert consensus on ventricular arrhythmias.
        Heart Rhythm. 2014; 11: e166-e196
        • Baher A.
        • Shah D.J.
        • Valderrabano M.
        Coronary venous ethanol infusion for the treatment of refractory ventricular tachycardia.
        Heart Rhythm. 2012; 9: 1637-1639
        • Lin C.Y.
        • Chung F.P.
        • Lin Y.J.
        • et al.
        Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: electrocardiographic characteristics and correlative anatomy.
        Heart Rhythm. 2016; 13: 111-121
        • Schurmann P.
        • Penalver J.
        • Valderrabano M.
        Ethanol for the treatment of cardiac arrhythmias.
        Curr Opin Cardiol. 2015; 30: 333-343
        • Kreidieh B.
        • Rodriguez-Manero M.
        • Schurmann P.
        • Ibarra-Cortez S.H.
        • Dave A.S.
        • Valderrabano M.
        Retrograde coronary venous ethanol infusion for ablation of refractory ventricular tachycardia.
        Circ Arrhythm Electrophysiol. 2016; 9: e004352
        • Yamada T.
        • McElderry H.T.
        • Doppalapudi H.
        • Okada T.
        • Murakami Y.
        • Yoshida Y.
        • Yoshida N.
        • Inden Y.
        • Murohara T.
        • Plumb V.J.
        • Kay G.N.
        Idiopathic ventricular arrhythmias originating from the left ventricular summit: anatomic concepts relevant to ablation.
        Circ Arrhythm Electrophysiol. 2010; 3: 616-623
        • Santangeli P.
        • Marchlinski F.E.
        • Zado E.S.
        • et al.
        Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit: outcomes and electrocardiogram correlates of success.
        Circ Arrhythm Electrophysiol. 2015; 8: 337-343
        • McAlpine W.A.
        Heart and Coronary Arteries.
        Springer-Verlag, New York1975
        • Enriquez A.
        • Malavassi F.
        • Saenz L.C.
        • Supple G.
        • Santangeli P.
        • Marchlinski F.E.
        • Garcia F.C.
        How to map and ablate left ventricular summit arrhythmias.
        Heart Rhythm. 2017; 14: 141-148
        • Rodriguez-Manero M.
        • Schurmann P.
        • Valderrabano M.
        Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation.
        Heart Rhythm. 2016; 13: 593-601