De Smet Maarten A J, Tavernier Rene, Duytschaever Mattias, Knecht Sébastien, le Polain de Waroux Jean-Benoît
Department of Cardiology, AZ Sint-Jan Hospital, Ruddershove 10, 8000 Brugge, Belgium.
Eur Heart J Case Rep. 2024 May 9;8(5):ytae235. doi: 10.1093/ehjcr/ytae235. eCollection 2024 May.
Left ventricular (LV) summit arrhythmias account for up to 14% of LV arrhythmias. The ablation of LV summit arrhythmias is challenging, as testified by the fact that radiofrequency (RF) catheter ablation failure is frequent. Retrograde coronary venous ethanol infusion has been proposed as an alternative approach for the ablation of LV summit arrhythmias.
A 47-year-old man with Lamin A/C cardiomyopathy was referred for the ablation of a pleiomorphic ventricular tachycardia (VT) storm, with dominant morphology compatible with LV summit origin. He first received a combined endo- and epicardial RF ablation with the elimination of three clinically relevant VTs. However, the dominant VT could not be ablated due to the proximity of the coronary vasculature and phrenic nerve and remained inducible. Accordingly, an urgent rescue redo procedure consisting of retrograde coronary venous ethanol ablation was performed. Based on the best pace-match and precocity, the first septal, retro-pulmonary branch and the first diagonal branch were infused with ethanol with immediate cessation of the tachycardia and non-inducibility. Anti-arrhythmic drugs were withdrawn, while guideline-directed medical therapy for heart failure was continued. No complications occurred. After 3 months, the patient remained free from any arrythmias.
Ablation of LV summit arrythmias is challenging, especially in the context of an electrical storm or in patients with structural heart disease. In such a situation, rescue ablation with retrograde coronary venous ethanol infusion represents an attractive alternative ablation modality.
左心室（LV）心尖部心律失常占左心室心律失常的比例高达14%。左心室心尖部心律失常的消融具有挑战性，射频（RF）导管消融失败很常见这一事实就证明了这一点。逆行冠状静脉乙醇注入已被提议作为左心室心尖部心律失常消融的一种替代方法。
一名47岁患有核纤层蛋白A/C心肌病的男性因消融多形性室性心动过速（VT）风暴而就诊，其主要形态与左心室心尖部起源相符。他首先接受了心内膜和心外膜联合射频消融，消除了三种临床相关的室性心动过速。然而，由于冠状动脉血管和膈神经距离较近，主要的室性心动过速无法消融，且仍可诱发。因此，进行了一项紧急抢救性再次手术，即逆行冠状静脉乙醇消融。根据最佳起搏匹配和早熟情况，向第一间隔支、肺后支和第一对角支注入乙醇，心动过速立即停止且不再可诱发。停用抗心律失常药物，同时继续进行针对心力衰竭的指南指导下的药物治疗。未发生并发症。3个月后，患者未再出现任何心律失常。
左心室心尖部心律失常的消融具有挑战性，尤其是在电风暴情况下或患有结构性心脏病的患者中。在这种情况下，逆行冠状静脉乙醇注入进行抢救性消融是一种有吸引力的替代消融方式。
