Key Points
- To evaluate the feasibility and safety of chemically destroying the atrioventricular node via selective catheterization and ethanol infusion in patients with drug-resistant atrial fibrillation.
- Conducted selective catheterization of the atrioventricular (AV) nodal artery using standard angioplasty techniques in 7 patients with symptomatic atrial fibrillation and uncontrollable ventricular rates.
- Administered 0.5–2 ml of 96% ethanol to ablate the AV node after confirming transient AV block with an initial infusion of isotonic iced saline.
- Complete AV block was successfully induced in 5 of 7 patients, while AV conduction was sufficiently modified to control symptoms in the remaining 2 patients.
- Minimal cardiac enzyme elevation occurred in 6 patients, whereas 1 patient suffered midright coronary artery occlusion leading to an inferior wall myocardial infarction after receiving 2 ml of ethanol.
Structured PICO
Does transcoronary chemical ablation with ethanol produce AV block in patients with symptomatic atrial fibrillation and uncontrollable ventricular rates?
PPopulation7 patients with symptomatic atrial fibrillation and uncontrollable ventricular rates
IInterventionTranscoronary chemical ablation of the atrioventricular (AV) node using 96% ethanol (0.5-2 ml) via selective catheterization of the AV nodal artery
OOutcomeProduction of complete AV block or modification of AV conduction to control symptomssurrogate
Transcoronary chemical ablation with ethanol can effectively produce AV block to control ventricular rates in atrial fibrillation, but carries a risk of coronary occlusion and myocardial infarction.