Ethanol septal ablation for refractory ventricular tachycardia

It is not uncommon for patients with severe ischemic or nonischemic cardiomyopathy to have recurrent ventricular arrhythmias. Many of these arrhythmias remain asymptomatic and can be controlled with beta-blockers or amiodarone. However, for a subset of these patients, the arrhythmia is persistent and requires antitachycardic pacing, internal defibrillation, or radiofrequency ablation therapy. We present a patient with end-stage nonischemic cardiomyopathy and recurrent ventricular tachycardia (VT) who was listed for cardiac transplantation. His VT was not responsive to medical management, and standard endocardial or epicardial VT radiofrequency ablation (VTRFA) procedures. Therefore, this patient underwent successful ethanol septal ablation (ESA) to obliterate the source of arrhythmia. Five days after the ablation procedure, he underwent cardiac transplantation. Therefore, this case presents a rare opportunity to review the use of ESA for refractory VT and an excellent opportunity to review the acute pathologic and histologic changes induced by ESA.