Coronary venous ethanol infusion for the treatment of refractory ventricular tachycardia

Radiofrequency catheter ablation (RFCA) is increasingly used to treat drug-refractory ventricular tachycardias (VTs). 1 Klein L.S. Shih H.T. Hackett F.K. Zipes D.P. Miles W.M. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation. 1992; 85: 1666-1674 Crossref PubMed Scopus (461) Google Scholar Although originally limited to endocardial VTs, access to the pericardial space via a nonsurgical subxyphoid technique has allowed RFCA to target epicardial circuits as well. 2 Sosa E. Scanavacca M. D'Avila A. Pilleggi F. A new technique to perform epicardial mapping in the electrophysiology laboratory. J Cardiovasc Electrophysiol. 1996; 7: 531-536 Crossref PubMed Scopus (652) Google Scholar Nevertheless, there still exists a subgroup of VTs that remain refractory to RFCA. This includes VTs with a deep intramural origin, from either reentrant or focal mechanisms. In addition, there are cases where proximity to the coronary vessels limits attempts at aggressive ablation of the VT origin. Finally, the epicardial approach for RFCA may be difficult, if not impossible, in cases of prior cardiac surgery. 3 Soejima K. Couper G. Cooper J.M. Sapp J.L. Epstein L.M. Stevenson W.G. Subxiphoid surgical approach for epicardial catheter-based mapping and ablation in patients with prior cardiac surgery or difficult pericardial access. Circulation. 2004; 110: 1197-1201 Crossref PubMed Scopus (137) Google Scholar