Electrophysiological and Electrocardiographic Characteristics of Ventricular Arrhythmias Successfully Treated by Coronary Venous Ethanol Ablation

Figures

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  Figure 1. Example of CVEA in LVA. In case 1, an ablation catheter was placed in the earliest endocardial site for indication in LAO (A) and RAO views (B). In case 24, a guidewire and balloon were advanced into the LVA for ethanol infusion. AIV = anterior interventricular vein; CVEA = coronary venous ethanol ablation; GCV = great cardiac vein; LAO = left anterior oblique; LVA = left ventricular annular vein; RAO = right anterior oblique; S1 = first septal vein.

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  Figure 2. 12-lead electrocardiographic (ECG) morphology of ventricular arrhythmias successfully eliminated by CVEA. A: 12-lead ECGs of all successful cases in which ethanol was delivered via the S1. B: Representative ECG comparison of S1 (case 11) with AIV targeting (case 18). The AIV example demonstrates a QS morphology in leads V1–V2 (red box), highlighting the distinct precordial pattern compared with S1-targeted cases. AIV = anterior interventricular vein; CVEA = coronary venous ethanol ablation; S1 = first septal vein.

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  Figure 3. Mapping and CVEA of PVC in AIV. Initial mapping in the RV found the EAT at the midseptum (A), but the local activation time did not precede QRS. (B) Coronary angiography was performed. C: Mapping using a guidewire showed that the EAT precedes QRS by 16 ms in the middle of the AIV. D: Double balloons were used for CVEA. E: During ethanol infusion, there was an “irritative” response, and then PVCs were eliminated. AIV = anterior interventricular vein; CVEA = coronary venous ethanol ablation; EAT = earliest activation time; LAO = left anterior oblique; RAO = right anterior oblique; RV = right ventricle; PVC = premature ventricular contraction.

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  Figure 4. Mapping and CVEA of PVC in S1. A: Initial mapping in the RVOT, LVOT, and CS found the EAT at the distal GCV. B: Coronary angiography was performed, which found that the S1 was near the earliest endocardial site. C: Unipolar mapping using a guidewire showed that the local activation in the S1 precedes QRS by 20 ms. D: CVEA was performed at the S1, and there was myocardial staining. AIV = anterior interventricular vein; CS = coronary sinus; CVEA = coronary venous ethanol ablation; EAT = earliest activation time; GCV = great cardiac vein; LAO = left anterior oblique; LVOT = left ventricular outflow tract; RAO = right anterior oblique; PVC = premature ventricular contraction; RVOT = right ventricular outflow tract; S1 = the first septal vein.

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  Figure 5. Mapping and CVEA of PVC in LVA. A: Initial mapping in the LVOT and CS found the EAT at the distal GCV. B: Coronary angiography was performed, which found that the LVA was near the earliest endocardial site. C: Unipolar mapping using a guidewire showed that the local activation in the LVA precedes QRS by 25 ms. D: CVEA was performed at the LVA, and there was myocardial staining. AIV = anterior interventricular vein; CS = coronary sinus; CVEA = coronary venous ethanol ablation; EAT = earliest activation time; GCV = great cardiac vein; LAO = left anterior oblique; LVA = left ventricular annular vein; LVOT = left ventricular outflow tract; RAO = right anterior oblique; PVC = premature ventricular contraction.