Retrograde coronary venous ethanol ablation via the irrigated ablation catheter for refractory left ventricular...

Retrograde coronary venous ethanol ablation (RCVEA) is effective for ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS). The aim of this study was to explore the feasibility, efficacy, and safety of RCVEA via the irrigated ablation catheter (RCVEA-IAC) in treating LVS-VAs.

Fourteen patients with idiopathic LVS-VAs were treated with RCVEA-IAC after radiofrequency ablation (RFA) failure attempts. An irrigated ablation catheter (six holes) was used for RFA and RCVEA-IAC. Ethanol was delivered via the ablation catheter at the site where a relatively early ventricular activation was recorded during premature ventricular contractions (PVCs) as well as the catheter was positioned just at the ostium of a branch of the coronary vein and venography confirmed no contrast spillage. A 12-lead ECG and 24-h Holter monitoring were performed during the follow-up period. Long-term success was defined as ≥ 80% reduction of PVCs burden determined by Holter-ECG.

RCVEA-IAC was performed in 14 patients (age 54.5 ± 16.5 years; 57.1% male) with LVS-VAs (50% accompanied by ventricular tachycardia). The median ethanol delivery was 4 mL. Acute procedural success was achieved in 10 patients (71.4%). In 8 patients, the VAs was successfully eliminated after ethanol infusion. In the other 2 patients, RFA performed again at the endocardial location closest to the ethanol-injected vein to eliminate the VAs. For patients with acute procedural failure, both ethanol infusion and RFA failed to eliminate the VAs in 2 patients. In 2 cases, the VAs still existed after ethanol infusion with minor changes of QRS morphology but resolved spontaneously within 24 h post-procedure. At a mean follow-up of 12.3 ± 5.5 months, 11 patients (78.6%) were free of recurrent VAs without antiarrhythmic drugs. One patient developed left anterior descending artery spasm during RCVEA-IAC and was relieved after nitroglycerin injection.

RCVEA-IAC is a safe and effective alternative strategy for the ablation of refractory LVS-VAs in selected patients after failure of conventional ablation.