Retrograde coronary venous ethanol ablation for patients with ventricular tachycardia and hypertrophic cardiomyopathy: A case report with real-time assessment of electrogram changes during ethanol infusion

Figure 1. A: Catheter position in the right anterior oblique projection. B: Twelve-lead electrocardiogram and electrogram at the anterior interventricular vein (AIV) during ventricular tachycardia (left) and sinus rhythm (right). Arrowheads and arrows indicate mid-diastolic potentials during ventricular tachycardia and delayed potentials during sinus rhythm, respectively. CS = coronary sinus; LV = left ventricle; p and d = proximal and distal electrodes; RV = right ventricle.

Figure 2. A: Coronary venography. Arrowhead indicates the targeted vein. B: Two 0.014-inch guidewires were crossed through the guiding catheter into the anterior interventricular vein (AIV). One guidewire was mounted with an over-the-wire (OTW) 2.7F microcatheter (EPstar Fix AIV, Japan Lifeline, Tokyo, Japan), and the other with a 1.2-mm OTW balloon (MINI TREK II, Abbott, Abbott Park, IL). The OTW balloon was inflated in the first septal branch of the AIV (arrowheads). C: Real-time electrogram changes during ethanol infusion from left to right, showing a gradual attenuation of the potential amplitudes and disappearance of the fragmented potentials between the far-field and near-field potentials (arrows).

Figure 3. A: Intraprocedural echocardiography revealed increased echogenicity in the basal left ventricular (LV) septum where ethanol was injected (arrowheads). B: Postoperative late gadolinium enhancement-cardiac magnetic resonance shows hypoenhancement in the LV summit region (arrowhead).