Table 2.
Results of transcoronary arterial ethanol ablation of ventricular tachycardia
Study reference |
Year | Study design |
Patients (n) |
Age (years) |
Indications | Follow-up | Results | Complications | Observations |
---|---|---|---|---|---|---|---|---|---|
Brugada et al. [24] |
1989 | Intracoronary 96% ethanol injection |
3 | 44, 61, 62 | Incessant tachycar- dia postmyocar- dial infarction |
2–9 months (mean 5.7) |
Cease of arrhythmia in 100% (one recur- rence at 1 month, repeating procedure successfully) |
Short-lasting chest pain in all the patients |
Chemical ablation of the arrhythmogenic resulted in cure of the disorder. Size of the ablation should be as limited as possible. |
Temporary complete AV block with pacemaker implantation in 1 patient (33%) |
New collateral blood supply may lead to recurrence. |
||||||||
Small to moderate AST rise |
|||||||||
| |||||||||
Kay et al. [25] |
1992 | Intracoronary 96% ethanol injection |
23 (10 received ethanol) |
59 ± 12 | Sustained monomor- phic ventricular tachycardia related to prior MI |
102–788 days (mean 372) |
Cease in 100%, with inducible VT in 3 patients (30%) |
Complete AV block in 4 patients (40%) |
Moderate degree of efficacy and potential for complications. Lo- ng-term control for particular patients. Limited by the fre- quent inability to localize the arrhyth- mia-related vessel. |
Little or no change in LVEF. |
Pericarditis (Dressler’s syndrome) in 1 patient (10%) |
||||||||
| |||||||||
Tokuda et al. [28] |
2011 | Intracoronary 96% ethanol injection |
27 – out of these, 22 received ethanol |
63 ± 13 | Symptomatic mono- morphic VT refrac- tory to RFA; structural heart disease |
20 ± 11 months |
VT was no inducible after ablation in 18 patients (82%) |
Complete heart block in 5 patients (38% of 13 patients with intact AV conduction) |
Important role for diffi- cult VTs in high-risk patients. Prevents recurrences in 36% and improves arrhyth- mia control in an additional 27%. |
VT recurrence in 14 patients (64%) |
Temporary coronary spasm 1 patient (5%) |
||||||||
Nine out of 11 were free from VT storm |
Total mortality 32%, early mortality (within 30 days) 14% and late mortality 18% |
||||||||
CK, CK-MB and Trop I elevation |
|||||||||
| |||||||||
Sacher et al. [32] |
2008 | Intracoronary 96% ethanol injection |
9 | 55 ± 9 | Refractory monomor- phic VT due to scar-related re- entry; ischemic cardiomyopathy in 6 patients (67%) |
29 ± 23 months |
No VT recurrence in 67% |
Transient ST-elevation during injection in 5 patients (55%) |
Applicable alternative especially in cases of septal scar (VT cir- cuits deep intramyo- cardial). TCEA rarely used (1.4%). |
No significant change in LVEF |
Immediate: transient severe hypotension in 2 patients (22%) and bilateral groin hemato- mas in 1 patient (11%) |
||||||||
CK-MB and Trop. I rise with injection |
-Three patients died in the follow-up from refrac- tory HF (33%). |
AST, aspartate aminotransferase; AV, Atrioventricular; CK, creatine kinase; CK-MB, creatine kinase MB; HF, heart failure; LVEF, Left ventricular ejection fraction; RFA, radiofrequency ablation; TCEA, transcoronary ethanol ablation; Trop. I, troponin I; VT, ventricular tachycardia.