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Preprocedural imaging to guide transcoronary ethanol ablation for refractory septal ventricular tachycardia
Author(s) -
RocaLuque Ivo,
RivasGándara Nuria,
FranciscoPascual Jaume,
RodriguezSanchez Jose,
CuellarCalabria Hug,
RodriguezPalomares Jose,
GarcíaDel Blanco Bruno,
PérezRodon Jordi,
SantosOrtega Alba,
RosésNoguer Ferran,
Marsal Roger,
Rubio Barbara,
García David GarcíaDorado,
Moya Mitjans Angel
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13816
Subject(s) - medicine , ventricular tachycardia , ablation , catheter ablation , radiology , coronary arteries , cardiology , refractory (planetary science) , magnetic resonance imaging , artery , physics , astrobiology
Background Radiofrequency ablation (RF) of ventricular tachycardia (VT) due to intramural foci has a high recurrence rate. Several techniques, such as bipolar ablation, irrigated needle ablation catheter, and retrograde coronary venous ethanol ablation have been suggested. Transarterial coronary ethanol ablation (TCEA) can also be effective. We present a case series of TCEA guided with preprocedural imaging to correlated coronary arteries and the intramural substrate. Methods and Results We present three consecutive patients with previous RF of septal VT (100% male; age, 72.6 ± 11.01 years; two patients with hypertrophic cardiomyopathy, one with mechanical aortic valve prosthesis) that underwent TCEA. Cardiac magnetic resonance was performed in two patients and cardiac CT in all patients. Correlation of septal arteries with intramural substrate was analyzed before the procedure so TCEA was attempted according to this analysis. After last TCEA (6.3 ± 2.08 months) the VT burden was reduced in all patients (sum of all implantable cardioverter‐defibrillator therapies [antitachycardia pacing and shock] before and after TCEA, 15.8 ± 3.73 vs 0.97 ± 0.63 therapies/month; P = 0.02). No complications occurred during TCEA. Conclusions TCEA completely guided with previous magnetic resonance imaging and computed tomography scan to select the coronary artery in relation to the substrate seems to be feasible as an alternative strategy in cases of intramural VT refractory to RF ablation.