Abstract 1736: Is There An Indication For Transcoronary Ethanol VT Ablation In 2007?
Introduction: TransCoronary Ethanol Ablation (TCEA) was proposed 15 years ago for incessant VTs resistant to any treatment (medications or ablation). However we sought to investigate whether this therapy could still be useful in the area of modern radiofrequency ablation.
Methods: Eight patients (6 males, 55 ±7yo, 2.1 ±0.8 failed VT ablations) out of 586 VT ablation procedures underwent TCEA between 2000 and 2006. After identification of the artery supplying blood to the arrhythmogenic area, an angioplasty balloon was advanced in the artery then VT was induced and cooled saline infusion was performed distal to the balloon. If this did not interrupt VT another artery was targeted. If VT stopped, 1 to 5 ml of pure ethanol (96%) was injected.
Results: All patients had scar related VT (septal:7, left inferior wall:1) with 4 pts having a non ischemic cardiomyopathy. Mean left ventricle ejection fraction prior to the procedure was 23 ±9%. In patients with septal scar, 1st and/or 2nd septal artery were targeted in 5 pts whereas for 2 this was not effective and a distal branch of the circumflex and the conus branch of the right coronary artery were targeted in 2. A branch of the posterior descending artery was targeted in the patient with inferior scar. Acute success was obtained in 5/8 (63%). Two patients experienced complications (transient cardiac stunning after ethanol infusion and delayed AV block). Twenty-four hours after the procedure, mean troponin Ic [0 – 0.1 ng/ml] and CPK-MB [0–5 ng/ml] were respectively 19.75 ±12.79 ng/ml and 121 ±108 ng/ml, mean ejection fraction was 18 ±8%(NS compared to before). With a mean follow-up of 29 ±23 months, 6/8 (75%) patients are still alive with no recurrence in 4 (50%).
Conclusion: TCEA is an option in cases of refractory VT who fail radiofrequency ablation, especially in cases of septal scar.