Suppression of Incessant Polymorphic Ventricular Tachycardia by Selective Intracoronary Ethanol Infusion

K. Okishige, T. C. Andrews, P. L. Friedman

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)188-195
Number of pages8
JournalPacing and Clinical Electrophysiology
Volume14
Issue number2
DOIs
StatePublished - Feb 1991

Keywords

  • chemical ablation
  • electrophysiology
  • myocardial infarction
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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