TY - JOUR
T1 - Suppression of Incessant Polymorphic Ventricular Tachycardia by Selective Intracoronary Ethanol Infusion
AU - Okishige, K.
AU - Andrews, T. C.
AU - Friedman, P. L.
PY - 1991/2
Y1 - 1991/2
N2 - Two weeks after an extensive anterior myocardial infarction, a 68‐year‐old man developed incessant polymorphic ventricular tachycardia (PMVT), unresponsive to all conventional treatment modalities. After requiring > 40 direct current cardioversions in < 3 hours, he underwent attempted intracoronary chemical ablation of his arrhythmia as a treatment of last resort. An infusion catheter was positioned selectively in the subtotally occluded left anterior descending (LAD) coronary artery, the putative “tachycardia‐related vessel.” Fifty percent ethanol was delivered to the anterior wall through this catheter by slow, constant infusion. Following selective intracoronary ethanol infusion, spontaneous, unprovoked episodes of PMVT ceased, despite discontinuation of all antiarrhythmic drugs. The LAD remained patent. Several days later, the patient underwent coronary artery bypass surgery and implantation of an implantable defibrillator, succumbing in the early postoperative period from recrudescent intractable ventricular fibrillation and cardiogenic shock. Slow intracoronary infusion of 50% ethanol does not cause abrupt vessel occlusion such as occurs after rapid injection of higher concentrations of ethanol. Selective intracoronary infusion of 50% ethanol may provide temporary lifesaving suppression of otherwise intractable polymorphic ventricular tachycardia.
AB - Two weeks after an extensive anterior myocardial infarction, a 68‐year‐old man developed incessant polymorphic ventricular tachycardia (PMVT), unresponsive to all conventional treatment modalities. After requiring > 40 direct current cardioversions in < 3 hours, he underwent attempted intracoronary chemical ablation of his arrhythmia as a treatment of last resort. An infusion catheter was positioned selectively in the subtotally occluded left anterior descending (LAD) coronary artery, the putative “tachycardia‐related vessel.” Fifty percent ethanol was delivered to the anterior wall through this catheter by slow, constant infusion. Following selective intracoronary ethanol infusion, spontaneous, unprovoked episodes of PMVT ceased, despite discontinuation of all antiarrhythmic drugs. The LAD remained patent. Several days later, the patient underwent coronary artery bypass surgery and implantation of an implantable defibrillator, succumbing in the early postoperative period from recrudescent intractable ventricular fibrillation and cardiogenic shock. Slow intracoronary infusion of 50% ethanol does not cause abrupt vessel occlusion such as occurs after rapid injection of higher concentrations of ethanol. Selective intracoronary infusion of 50% ethanol may provide temporary lifesaving suppression of otherwise intractable polymorphic ventricular tachycardia.
KW - chemical ablation
KW - electrophysiology
KW - myocardial infarction
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=0025971644&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025971644&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8159.1991.tb05089.x
DO - 10.1111/j.1540-8159.1991.tb05089.x
M3 - Article
C2 - 1706504
AN - SCOPUS:0025971644
SN - 0147-8389
VL - 14
SP - 188
EP - 195
JO - Pacing and Clinical Electrophysiology
JF - Pacing and Clinical Electrophysiology
IS - 2
ER -