PO-624-04 ADVANCED TECHNIQUES TO MAXIMIZE TISSUE REACH OF CORONARY VENOUS ETHANOL IN ABLATION-REFRACTORY VENTRICULAR ARRHYTHMIAS

Abstract

Venous ethanol infusion can treat ablation-refractory ventricular arrhythmias (VAs). Ethanol tissue delivery can be compromised by collateral flow and technical challenges cannulating intramural veins in complex anatomies. To develop advanced and multi-balloon approaches to ethanol delivery in complex venous anatomy. 14 patients referred for initial ablation (n=4) or after failed ablation (n=10) underwent endocardial (n=14), epicardial (n=1), and coronary venous mapping (n=14). 7 patients had left ventricular summit VAs, and 7 had scar-mediated VAs. Double or triple balloons were used in the coronary veins. Advanced strategies for ethanol delivery include use of secondary balloons to (1) block collateral flow in a target vein (2) block collateral flow into a non-target vein (3) cannulate collaterals to reach a target vein that is not easily accessible via its ostium (4) serve as a distal mechanical block to facilitate more proximal vein cannulation and (5) occlude the coronary sinus to allow ostial delivery of ethanol in a branch vessel. Successful ethanol infusion was accomplished in the following target veins: LV annular (n=2), septal (n=6), lateral (n=1), middle cardiac (n=1), anterolateral (n=2) and postero-lateral (n=3). At median follow up of 130.5 days, no patients experienced recurrences. Utilization of collaterals between non-target and target veins can facilitate ethanol delivery with the multiple balloon technique. Understanding of CS venous anatomy and advanced approaches to balloon deployment may increase the efficacy of venous ethanol for treatment of VAs.