Table 1.
Results of transcoronary ethanol ablation of the atrioventricular node
| Study reference |
Year | Study design |
Patients (n) |
Age (years) |
Indications | Follow-up | Results | Complications | Conclusions |
|---|---|---|---|---|---|---|---|---|---|
| Brugada et al. [18] |
1990 | Intracoronary 96% ethanol injection |
7 | 64.3 ± 5.4 | Atrial fibrillation with rapid ventricular rates. Normal coron- aries. Free from struc- tural heart disease. |
1–7 months (mean 4) |
Complete AV block: 5 patients (71%) |
100% transient chest pain |
Successful approach. Delivering catheter should be appropri- ately wedged to pre- vent ethanol backflow. |
| Modified AV conduc- tion and symptom control: 2 patients (29%) |
Inferior wall MI: 1 patient (14%) |
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| Minimal enzyme rise (AST): 6 patients (86%) |
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|
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| Kay et al. [19] |
1991 | Intracoronary 96% ethanol injection |
12 (10 received ethanol) |
57.9 ± 13.3 | Atrial fibrillation 4, atrial flutter 4, AV node re-entrant tachy- cardia 3, ectopic atrial tachycardia 1 |
48–216 days (mean 134.8) |
Complete AV block at discharge: 10 patients (100%) |
100% transient chest pain |
Feasible and low-risk procedure. Reflux into the distal right coron- ary artery may occur. |
| Recovery of AV conduc- tion at follow-up: 3 patients (30%) |
ST-segment elevation inferior leads (reflux into the distal RCA): 2 patients (20%) with enzyme rise (CKMB) |
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|
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| Sneddon et al. |
1991 | Intracoronary dehy- drated alcohol injection |
14 (10 received ethanol) |
54–75 (mean 64) |
Refractory atrial flutter or fibrillation |
4–7months (mean 5.35) |
Complete AV block immediately after injection in all the patients |
Modest transient rise in CK-MB |
Feasible approach. Modest success rate and potential compli- cations reserve this technique as an alternative after fail- ure of other ablative treatments. |
| AV conduction returned in 4 patients (40%) |
Chest discomfort. | ||||||||
| VFib in 2 patients (20%) with contrast injection |
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| Coronary artery spasm in 3 patients after cold saline injection (21%) |
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| Strickberger et al. [21] |
1993 | Intracoronary 25% ethanol injection |
11 (9 received ethanol) |
56.5 ± 8.1 | Atrial fibrillation and rapid ventricular response |
19–25 months (mean of 22.2 ±2.2) |
‘Clinical success’ (ventri- cular rate control or complete AV block in) 7 patients (78%) |
Transient modest rise in CK-MB |
Acute effects of diluted ethanol on the AV node did not predict long-term outcome. Similar effect to rapid administration of 96% ethanol. |
| Permanent ventricular rate control without causing AV block in 4 patients (44%) |
Fever and positive blood cultures after placement of tempor- ary transvenous pace- maker following ethanol injection |
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| No significant change in LVEF |
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AST, aspartate aminotransferase; AV, Atrioventricular; CK, creatine kinase; CK-MB, creatine kinase MB; LVEF, Left ventricular ejection fraction; Ml, myocardial infarction.