Myocardial dissection following successful chemical ablation of ventricular tachycardia

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Interventional Cardiology

Background:

• Incessant ventricular tachycardia (IVT) is a life-threatening arrhythmia.
• Transcoronary chemical ablation (TCA) using ethanol is an alternative treatment for refractory IVT.
• Successful ablation aims to eliminate the arrhythmogenic substrate without causing significant cardiac damage.

Observation:

• A patient undergoing successful TCA for IVT experienced a fatal complication.
• Post-mortem examination revealed myocardial rupture and cardiac tamponade.
• Histopathology identified a subepicardial dissection at the ethanol ablation site.

Findings:

• The myocardial rupture was associated with fibrous and fatty degeneration of the heart muscle.
• This represents a previously undocumented lethal complication of ethanol ablation therapy.
• The ablation procedure, while successful in controlling VT, led to catastrophic cardiac damage.

Implications:

• This case underscores the potential risks associated with ethanol ablation for ventricular tachycardia.
• Clinicians should exercise caution and consider this rare but severe complication.
• Further research may be needed to elucidate the mechanisms and risk factors for myocardial rupture after ethanol ablation.