Baskovski Emir, Büyükçakır İrem Cenan, Altın Timuçin, Akyürek Ömer
Department of Cardiology, Ankara University, Faculty of Medicine, Ankara, Türkiye.
Turk Kardiyol Dern Ars. 2025 Mar;53(2):134-139. doi: 10.5543/tkda.2024.21859.
Catheter-based radiofrequency (RF) ablation is a recommended treatment modality for various ventricular arrhythmias. However, challenging sites that may not be accessible due to anatomical reasons, as well as intramural sites, where RF energy penetration may be limited, pose challenges that limit the success rate of RF ablation. Ethanol ablation may be an alternative option for treatment of ventricular arrhythmias that are not amenable to treatment by RF ablation. This report describes two cases of successful venous alcohol ablation for refractory ventricular tachycardia to standard RF ablation procedure. In the first case, a patient with a ventricular tachycardia (VT) originating from intramural outflow tract, having failed an endocardial ablation, underwent a successful ethanol ablation, via a double balloon technique. In the second case, we describe a patient with a history of transcatheter aortic valve replacement and premature ventricular complexes (PVCs) originating from intramural outflow tract. Radiofrequency ablation in this patient was limited by both the far-field appearing signals and the proximity prosthetic valve to the site of these signals. Therefore, this patient also underwent successful ethanol ablation of annular vein with the over the wire system after venography of coronary sinus. No complications were observed in both patients. In conclusion, coronary venous ethanol ablation may be a safe and successful technique for ablation of intramural ventricular arrhythmias in different clinical scenarios.
基于导管的射频（RF）消融是治疗各种室性心律失常的推荐治疗方式。然而，由于解剖学原因可能无法到达的具有挑战性的部位，以及射频能量穿透可能受限的壁内部位，带来了限制射频消融成功率的挑战。乙醇消融可能是治疗不适用于射频消融的室性心律失常的一种替代选择。本报告描述了两例采用静脉酒精消融成功治疗难治性室性心动过速的病例，这些病例对标准射频消融程序无效。在第一例中，一名起源于壁内流出道的室性心动过速（VT）患者，心内膜消融失败后，通过双球囊技术成功进行了乙醇消融。在第二例中，我们描述了一名有经导管主动脉瓣置换术病史且起源于壁内流出道的室性早搏（PVCs）患者。该患者的射频消融受到远场出现信号以及人工瓣膜与这些信号部位接近程度的限制。因此，该患者在冠状静脉窦造影后也通过钢丝系统成功进行了环形静脉乙醇消融。两名患者均未观察到并发症。总之，冠状静脉乙醇消融可能是在不同临床情况下消融壁内室性心律失常的一种安全且成功的技术。
