Permanent AV block or modification of AV nodal function by selective AV nodal artery ethanol infusion

The acute and chronic effects of selective AV nodal artery ethanol infusion on AV nodal function was studied in 9 closed chest anesthetized dogs. Using standard percutaneous techniques of arterial catheterization, a 2.2 French infusion catheter was positioned in the AV nodal artery. Ten minute infusions into the AV nodal artery of 25%, 50%, or 100% ethanol in normal saline at rates of 0.5 mL/min acutely resulted in complete AV nodal block (AVB) in 5 dogs, 2:1 AV nodal block in 1 dog, and prolongation of AV nodal effective refractory period and/or Wenckebach cycle length in the remaining 3 dogs. One dog died with persistent complete AV block 1 week after the ethanol infusion. When restudied 4 weeks later, 7 of the 8 surviving dogs had persistent modification of AV nodal function, including complete AV block in 5 dogs and lengthening of AV nodal effective refractory period and/or Wenckebach cycle length without AV block in 2 dogs. Pathologic examination of the animals exhibiting chronic modification or ablation of AV nodal function revealed healing infarction of the AV node or its approaches. Distant myocardial necrosis was not observed and left ventricular function was normal. Slow infusion of low concentrations of ethanol into the AV nodal artery results in AV nodal modification or ablation due to localized necrosis in or around the AV node. This technique may have a role in AV nodal modification or ablation, particularly in patients who have failed DC shock or radiofrequency ablation.