Coronary venous ethanol infusion for treatment of refractory ventricular arrhythmias

Coronary venous ethanol infusion or coronary venous ethanol ablation (CVEA) has been used to treat ventricular arrhythmias (VAs) refractory to radiofrequency ablation (RFA).

This single-center study aimed to describe acute- and subacute-term safety and efficacy of CVEA for the management of refractory VAs.

Patients who underwent CVEA for refractory ventricular tachycardia (VT) or premature ventricular contractions (PVCs) at our center were included. Coronary venous anatomy was delineated, and VAs were mapped in epicardial or septal veins in addition to traditional mapping techniques. Ethanol was infused in the target vessel based on anatomy, size of target veins, and collateral flow.

A total of 30 patients (aged 61.4 ± 12.5 years; 90% men, 80% white) underwent 32 ablation procedures with CVEA for refractor-y VT (n = 20) or PVCs (n = 12). There were 28 patients (93%) who had undergone RFA previously and 28 who had failed anti-arrhythmic drugs. In the VT ablation cohort, acute suppression of clinical VT was achieved after CVEA in 15 cases (75%); 1 (5%) required additional RFA, 1 was non-inducible at baseline, and 3 (15%) remained inducible for clinical VT. During follow-up, targeted VT recurred in 3 (15%) and new VTs occurred in 7 cases (35%). In the PVC ablation cohort, acute suppression was achieved in 11 patients (92%). During follow-up, PVC suppression was sustained in these 11 patients with reduction in PVC burden from 24.8% ± 13.9% to 2.1% ± 2.1%. Complications potentially related to CVEA included complete heart block (2), transient left bundle branch block (1), pericardial effusion (1), and cardiogenic shock (2).

CVEA can be effective for management of complex VAs refractory to standard RFA with an acceptable safety profile.