Radiofrequency catheter ablation (RFCA) is the first-line therapy for treatment of drug refractory ventricular arrhythmias (VAs), however, creating a safe, transmural lesion can be difficult. Ethanol in the arterial system has been used as an adjunctive therapy to RFCA since 1986, but with limited use due to technical and efficacy limitations. Venous ethanol is emerging as powerful alternative.