Transcoronary chemical ablation of atrioventricular conduction.

Abstract

In seven patients with symptomatic atrial fibrillation and uncontrollable ventricular rates, selective catheterization of the atrioventricular (AV) nodal artery was performed to chemically destroy the AV node. Ethanol at a concentration of 96% and a dose of 0.5-2 ml was used after selective catheterization of the AV nodal artery had demonstrated temporary AV block after the administration of isotonic iced saline. Complete AV block was produced in five patients and AV conduction was sufficiently modified to control symptoms in the remaining two patients. A minimal enzyme rise occurred in six patients. A severe complication in the remaining patient occurred when, after 2 ml ethanol in the AV nodal artery, occlusion developed in the midright coronary artery that led to an inferior wall myocardial infarction. It is concluded that the AV nodal artery can be selectively catheterized using presently available angioplasty techniques. Ethanol can be used to destroy the AV node and block AV conduction. (Circulation 1990;81:757-

Ethanol for the treatment of cardiac arrhythmias

“…The usual dose implemented for AVN ablation with selective intracoronary injection was ethanol 95%, as a bolus of 0.5–2 ml per dose over 1–4 s and up to three times. Efficacy and safety of AVN ablation with ethanol was rapidly confirmed by other groups [19,20], although the long-term success appeared to be variable [18-21]. The rate of success ranges between 58 and 72%.…”

“…Brugada et al [17] were the first to demonstrate termination of atrioventricular re-entry by cannulating the AVN artery and infusing cold saline into it. Proof-of-concept canine studies showed AVN block after absolute ethanol infusion in the AVN artery [18]. The feasibility of achieving complete, durable AVN block by ethanol infusion in the AVN artery was then proven in six patients [12].…”

Alcohol ablation of atrioventricular conduction.

“…The procedure was significantly more successful when 1 0 ml rather than 0 5 ml alcohol was used. The initial choice of a dose of 1 0 ml was based on the reports of Brugada et al 5 In an attempt to minimise myocardial damage we reduced the dose but this led to reduced success with no change in enzyme release and so we returned to 1-0 ml for the last patient in the series. Enzyme release was not related to the amount of alcohol injected or the technical success of the procedure.…”

“…Atrioventricular block can be achieved with a much smaller dose of cold saline than has been previously reported; 1-2 ml is sufficient if the catheter is properly wedged within the artery. 5 We have more recently abandoned the use of cold saline if dilute contrast produces convincing evidence that the correct vessel has been catheterised. A combination of these precautions and prophylactic intracoronary nitrates should minimise the risk of spasm.…”

Alcohol Ablation of Ventricular Tachycardia

“…An additional technique, transcoronary alcohol ablation of ventricular tachycardia, was originated experimentally in dogs' and bas recently been used clinically. [2][3][4] The goals of this approach were twofold: to bypass the thickened scarred endocardium that might impede the utility of endocardial catheter ablation techniques for patients with ventricular tachycardia due to coronary disease; and to target antiarrhythmic therapy to the specific arrhythmogenic area.^ The technique involves identifying the arrhythmic focus using intracardiac mapping witb catheter electrodes. Then the coronary artery supplying this area is identified angiog rap hi cally.…”