Retrograde venous ethanol ablation for ventricular tachycardia

Radiofrequency catheter ablation (RFCA) has been considered the first-line therapy for treatment of drug-refractory ventricular arrhythmias (VAs). 1 Pedersen C.T. Kay G.N. Kalman J. et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 2014; 11: e166-e196 Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar The success of catheter ablation depends on our ability to reach the anatomic location of the ventricular tachycardia (VT) substrate. VTs arising from deep intramural regions 2 Baher A. Shah D.J. Valderrabano M. Coronary venous ethanol infusion for the treatment of refractory ventricular tachycardia. Heart Rhythm. 2012; 9: 1637-1639 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar or in close proximity to coronary vessels 3 Lin C.Y. Chung F.P. Lin Y.J. et al. Radiofrequency catheter ablation of ventricular arrhythmias originating from the continuum between the aortic sinus of Valsalva and the left ventricular summit: electrocardiographic characteristics and correlative anatomy. Heart Rhythm. 2016; 13: 111-121 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar can have limited RFCA success. Transarterial coronary ethanol ablation has been used as an alternative treatment option and is reasonably successful in treating RFCA-refractory VTs. 4 Schurmann P. Penalver J. Valderrabano M. Ethanol for the treatment of cardiac arrhythmias. Curr Opin Cardiol. 2015; 30: 333-343 Crossref PubMed Scopus (17) Google Scholar However, it is limited by technical difficulties and potential complications inherent to coronary arterial instrumentation, such as coronary artery dissection and unintended collateral damage in incomplete balloon seals. Other complications include complete atrioventricular block and pericarditis. 4 Schurmann P. Penalver J. Valderrabano M. Ethanol for the treatment of cardiac arrhythmias. Curr Opin Cardiol. 2015; 30: 333-343 Crossref PubMed Scopus (17) Google Scholar Retrograde coronary venous ethanol ablation (RCVEA) has been described as an alternative treatment to the arterial approach. RCVEA overcomes some of the limitations associated with transarterial coronary ethanol ablation and avoids instrumentation of the coronary arteries.