Ethanol Delivery Research Articles

Ethanol-paired conditioned stimulus effects on concurrent reinforced responding for ethanol and food.

The influence of Pavlovian Conditioned Stimuli (CS) on ethanol self-administration and choice between ethanol and an alternative are potentially important. Ethanol-paired CS might increase ethanol self-administration, especially when it has been reduced during recovery, though the selectivity of these increases has been questioned. To date, one study examined the effects of an ethanol-paired CS on ethanol choice and found that the CS increased ethanol-responding more than food-responding when both were in extinction. However, it remains unclear whether ethanol-paired CS increase ethanol-choice that is not in extinction. Here, we examine the effects of an ethanol-paired CS on ethanol-choice when both food- and ethanol-responding are reinforced. Sixteen adult male Lewis rats were trained on a concurrent schedule to respond for ethanol on one lever and for food on the other lever. Ethanol was available under an FR 5 schedule, and food was available under an FR schedule that was adjusted for each rat to earn an equal number of food and ethanol deliveries. Then, 2-min light presentations were paired with an RT 25-sec schedule of ethanol delivery for 10 sessions in the absence of both levers. After this, subjects were placed back on the concurrent schedule for one session, then five sessions with the CS being present or absent on each trial of the concurrent schedule occurred. Rats learned to respond on one lever for ethanol and on the other for food and earned similar numbers of ethanol and food deliveries. During Pavlovian Conditioning, the number of head entries into the head-entry detector was higher in the presence of the CS than in its absence. In the test sessions, rats made more ethanol responses in the presence of the CS than in its absence. However, this effect was small and did not increase the amount of ethanol earned. Thus, ethanol-paired CS could increase ethanol-responding under a choice procedure but did not increase ethanol consumption meaningfully under the studied conditions.

Usage of Rapeseed Oil and Ethanol in a Diesel Engine

Introduction. Alternative fuels in IC-engines make it possible to reduce the harmful effects of exhaust gases on the environment without the use of expensive cleaning systems, diversify the fuel market, and reduce the consumption of non-renewable energy recourses, while research aimed at studying the use of alternative fuels makes it possible to find optimal options for replacing non-renewable raw materials. The purpose of the work is to study the effect of using ethanol in a standard tractor diesel engine with volumetric mixing and combustion from flare resulting from the autoignition of a rapeseed oil pilot portion and to optimize separate cyclic fuel deliveries to obtain maximum energy and environmental effect. Materials and Methods. The article deals with the description of the results of the use of rapeseed oil and ethanol in a serial tractor diesel engine of dimension 2F 10.5/12.0 with separate fuel injection directly into the combustion chamber. In the course of experimental studies, the working process was indicated by a piezo quartz pressure sensor installed in the cylinder head, fuel and air consumption were measured, and samples of exhaust gases to study the gas composition and determine the content of toxic components and smokiness were taken. Results. The exact ethanol and rapeseed oil delivery was determined; the values of the average effective pressure, the average temperature of gases in the cylinder, and active and full heat generation were obtained. It is shown that with an increase in the cyclic ethanol delivery, the proportion of heat from kinetic combustion increases, while the diesel process is characterized by an increase in the proportion of diffusion combustion when the load increases. The analysis of the processes inside the cylinder when the engine runs on ethanol and rapeseed oil in comparison with the traditional diesel process is carried out. Discussion and Conclusion. The use of rapeseed oil and ethanol can completely replace the traditional fuel of petroleum origin for an operating diesel engine by installing additional fuel equipment and modifying the head of cylinder block through mounting an additional nozzle. In this case, the environmental performance of the diesel engine improves significantly.

Conditioned stimulus effects on paired or alternative reinforcement depend on presentation duration: Implications for conceptualizations of craving.

Conditioned stimuli (CS) associated with alcohol ingestion are thought to play a role in relapse by producing a craving that in turn increases motivation to drink which increases ethanol-seeking and disrupts other ongoing behavior. Alternatively, such CS may provide information indicating a likely increase in the density of the paired unconditioned stimulus and simultaneously elicit behavior that may be incompatible with other ongoing behavior, i.e., approach toward the CS. To explore these possibilities, rats were trained to respond for ethanol or food in two different components of the same session after which a light above the ethanol-lever was lighted twice during each component and each light presentation was followed by ethanol delivery. The duration of this CS was 10 s initially and then increased to 30 s, then to 100 s, and finally returned to 30 s. The change in responding for ethanol or food was compared to a matched period immediately preceding CS presentation. The CS presentation increased responding to ethanol, and this effect increases with longer CS presentations. In contrast, the CS presentation decreased responding to food, and this effect decreases with longer CS presentations. These results appear to support the informational account of CS action rather than simply a change in the motivation to seek and consume ethanol. This suggests that craving as it is commonly understood likely represents multiple behavioral processes, not simply increased desire for alcohol and that reports of craving likely reflect labeling based upon past experiences rather than a cause of future drug-taking.

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

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.

Nicotine Enhances Goal-Tracking in Ethanol and Food Pavlovian Conditioned Approach Paradigms.

RationaleNicotine promotes alcohol intake through pharmacological and behavioral interactions. As an example of the latter, nicotine can facilitate approach toward food- and alcohol-associated stimuli (“sign-tracking”) in lever-Pavlovian conditioned approach (PavCA) paradigms. However, we recently reported that nicotine can also enhance approach toward locations of reward delivery (“goal-tracking”) triggered by ethanol-predictive stimuli when the location of ethanol delivery is non-static (i.e., a retractable sipper bottle).ObjectiveTo determine whether the non-static nature of the reward location could have biased the development of goal-tracking in our previous study (Loney et al., 2019); we assessed the effect of nicotine in a lever-PavCA paradigm wherein the location of ethanol delivery was static (i.e., a stationary liquid receptacle). Then, to determine whether nicotine’s enhancement of goal-tracking is unique to ethanol-predictive stimuli, we assessed the effect of systemic nicotine on approach triggered by food-predictive stimuli in a lever-PavCA paradigm.MethodsLong–Evans rats were used in two PavCA experiments wherein a lever predicted the receipt of ethanol (15% vol/vol; experiment 1) or food (experiment 2) into a stationary receptacle. Prior to testing, rats were administered nicotine (0.4 mg/kg subcutaneously) or saline systemically.ResultsIn both experiments, nicotine increased measures of goal-tracking, but not sign-tracking.ConclusionNicotine can facilitate approach to reward locations without facilitating approach to reward-predictive stimuli. As such, conceptualization of the mechanisms by which nicotine affects behavior must be expanded to explain an enhancement of goal-tracking by nicotine.

Effects of ethanol port injection timing and delivery rate on combustion characteristic of a heavy-duty V-12 diesel engine

Using biobased fuels in Diesel engines is an effective solution reduce the generation of toxic components in the exhaust gas. One of them, alcohol, is the potential fuel to reduce emissions and dependence on fossil fuels. So, this study is aimed to investigate the effects of ethanol port injection timing and delivery rate on the combustion characteristic of a heavy-duty V-12 Diesel engine when ethanol substitution percentage is 30% to reach the original diesel quantity at full load. The combustion characteristic analysis indicates that the variation in cylinder gas pressure and temperature decreases when retarded ethanol injection timing and decreased ethanol delivery rate, the engine works more smoothly due to the maximum rate of pressure rise decreases. However, the changes are greater when changing the ethanol injection timing as compared to ethanol delivery rate case.

Vein of Marshall ethanol infusion in the treatment of atrial fibrillation: From concept to clinical practice

The vein of Marshall (VOM) contains innervation, myocardial connections, and arrhythmogenic foci that make it an attractive target in catheter ablation of atrial fibrillation (AF). Additionally, it co-localizes with the mitral isthmus, which is critical to sustain perimitral flutter, and is a true atrial vein that communicates with underlying myocardium. Retrograde balloon cannulation of the VOM from the coronary sinus is feasible and allows for ethanol delivery, which results in rapid ablation of neighboring myocardium and its innervation. Here we review the body of work performed over a span of 13 years, from the inception of the technique, to its preclinical validation, to demonstration of its ablative and denervation effects, and finally to completion of a randomized clinical trial demonstrating favorable outcomes, improving rhythm control in catheter ablation of persistent AF.

The liposomal delivery of hydrophobic oxidovanadium complexes imparts highly effective cytotoxicity and differentiating capacity in neuroblastoma tumour cells

Oxidovanadium complexes with organic ligands are well known to have cytotoxic or differentiating capabilities against a range of cancer cell types. Their limited use in clinical testing though has resulted largely from uncertainties about the long-term toxicities of such complexes, due in part to the speciation to vanadate ions in the circulation. We hypothesised that more highly stable complexes, delivered using liposomes, may provide improved opportunities for oxidovanadium applications against cancer. In this study we sourced specifically hydrophobic forms of oxidovanadium complexes with the explicit aim of demonstrating liposomal encapsulation, bioavailability in cultured neuroblastoma cells, and effective cytotoxic or differentiating activity. Our data show that four ethanol-solubilised complexes with amine bisphenol, aminoalcohol bisphenol or salan ligands are equally or more effective than a previously used complex bis(maltolato)oxovanadium(V) in neuroblastoma cell lines. Moreover, we show that one of these complexes can be stably incorporated into cationic liposomes where it retains very good bioavailability, apparently low speciation and enhanced efficacy compared to ethanol delivery. This study provides the first proof-of-concept that stable, hydrophobic oxidovanadium complexes retain excellent cellular activity when delivered effectively to cancer cells with nanotechnology. This offers the improved prospect of applying oxidovanadium-based drugs in vivo with increased stability and reduced off-target toxicity.

Double-balloon technique for retrograde venous ethanol ablation of ventricular arrhythmias in the absence of suitable intramural veins

Venous ethanol infusion via an occlusive balloon has been used as a bailout approach to treat ablation-refractory ventricular arrhythmias (VAs). Unfavorable venous anatomy (lack of intramural veins at the targeted site or collateral vein-ethanol shunting) limits its efficacy. Blocking collateral flow with a second balloon may optimize myocardial ethanol delivery. The purpose of this study was to validate the "double-balloon" approach to enhance ethanol delivery in cases of unfavorable venous anatomy. Eight patients referred after failed ablations (3 left ventricular [LV] summit, 5 scar-related ventricular tachycardia) underwent endocardial mapping and additional radiofrequency ablation without VA resolution. Coronary veins were mapped using a multipolar catheter or wire, and selective venograms were obtained. The double balloon was used when (1) distal collateral branches shunted flow away from the targeted region; (2) the target vein had optimal signals only proximally; or (3) a large vein was targeted that had multiple branches for a large area of interest. Acute successful ethanol infusion myocardial delivery and resolution of VA was accomplished using the posterolateral LV veins (n = 2 patients, 3 procedures), lateral LV vein (n = 1), apical anterior interventricular vein (AIV; n = 1), middle cardiac vein (n = 1), and septal branches of the AIV (n = 3). At median follow-up of 313.5 days, 2 patients experienced recurrence. The double-balloon technique can enhance ethanol delivery to target isolated vein segments, block collateral flow, or target extensive areas, and can expand the utility of venous ethanol for treatment of VAs.

Flypub To Study Ethanol Induced Behavioral Disinhibition and Sensitization.

Alcohol use disorder (AUD) remains a serious problem in our society. To develop effective interventions for addiction, it is important to understand the underlying neurobiological mechanisms, for which diverse experimental approaches and model systems are needed. The main ingredient of alcoholic beverages is ethanol, which causes adaptive changes in the central nervous system and behavior upon chronic intake. Behavioral sensitization (i.e., escalated responses) in particular represents a key adaptive change underlying addiction. Most ethanol-induced behavioral sensitization studies in animal models have been conducted on the locomotor activating effect of ethanol. A prominent effect of ethanol is behavioral disinhibition. Behavioral sensitization to the disinhibition effect of ethanol, however, is underrepresented. To address this issue, we developed the Flypub assay that allows measuring the escalated increase in disinhibited courtship activities upon recurring ethanol exposure in Drosophila melanogaster.Here, we report the step-by-step Flypub assay including assembly of ethanol exposure chambers, setup of the assay station, criteria for fly care and collection, ethanol delivery, quantification of disinhibited courtship activities, data processing and statistical analysis. Also provided are how to troubleshoot critical steps, overcome limitations and expand its utility to assess additional ethanol-induced behaviors. The Flypub assay in combination with powerful genetic tools in Drosophila melanogaster will facilitate the task of discovering the mechanism underlying ethanol-induced behavioral sensitization.

Honeybees show adaptive reactions to ethanol exposure

The honeybee is being developed as a simple invertebrate model for alcohol-related studies. To date, several effects of ethanol consumption have been demonstrated in honeybees, but the tolerance effect, one of the hallmarks of alcohol overuse, has never been shown. Here, we confirm our hypothesis that the response to ethanol (in terms of motor impairment) is lower in bees that have previously experienced intoxication than in bees encountering ethanol for the first time, indicating that the chronic tolerance effect occurs in honeybees. Furthermore, we investigated the basis of this effect and found that it likely results from conditioned compensatory responses to cues associated with ethanol delivery. Our findings significantly improve our understanding of the suitability of honeybees as models for alcoholism-related research and underline the first and foremost function of all conditioned reactions – their adaptive value.

Sustained alterations in neuroimmune gene expression after daily, but not intermittent, alcohol exposure

Acute ethanol intoxication is associated with Rapid Alterations in Neuroimmune Gene Expression (RANGE), including increased Interleukin (IL)-6 and Nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha (IκBα), and suppressed IL-1β and Tumor necrosis factor (TNF) α, yet little is known about adaptations in cytokines across the first few ethanol exposures. Thus, the present studies examined central cytokines during intoxication (3h post-ethanol) following 2, 4 or 6 intragastric ethanol challenges (4g/kg) delivered either daily or every-other-day (EOD). Subsequent analyses of blood ethanol concentrations (BECs) and corticosterone were performed to determine whether the schedule of ethanol delivery would alter the pharmacokinetics of, or general sensitivity to, subacute ethanol exposure. As expected, ethanol led to robust increases in IL-6 and IκBα gene expression in hippocampus, amygdala and bed nucleus of the stria terminalis (BNST), whereas IL-1β and TNFα were suppressed, thereby replicating our prior work. Ethanol-dependent increases in IL-6 and IκBα remained significant in all structures – even after 6 days of ethanol. When these doses were administered EOD, modest IL-6 increases in BNST were observed, with TNFα and IL-1β suppressed exclusively in the hippocampus. Analysis of BECs revealed a small but significant reduction in ethanol after 4 EOD exposures – an effect which was not observed when ethanol was delivered after 6 daily intubations. These findings suggest that ethanol-induced RANGE effects are not simply a function of ethanol load per se, and underscore the critical role that ethanol dosing interval plays in determining the neuroimmune consequences of alcohol.

Long-lasting effect of NMDA receptor antagonist memantine on ethanol-cue association and relapse.

It is well known that the glutamatergic system plays a crucial role in alcohol addiction and especially in relapse-like behaviour. However, results of clinical studies on compounds that influence the activity of the glutamatergic system have been disappointing so far. The aim of our study was to establish treatment conditions under which the N-methyl-d-aspartate receptor (NMDAR) antagonist memantine may produce more reliable treatment effect with respect to alcohol relapse-like behaviour. For this purpose, male Wistar rats were trained to associate several discrete stimuli with ethanol delivery. Thereafter, half of the animals received a brief memory reactivation session followed by two administrations of 20 mg/kg of memantine, while the other half received the same treatment without memory reactivation. Afterwards, a cue-induced ethanol-seeking behaviour test was performed followed by repeated extinction sessions and a reacquisition test. Our data show that administration of memantine reduced responding on the ethanol-associated lever in a cue-induced ethanol-seeking test. This reduction did not depend on whether or not a memory reactivation session was introduced prior to memantine administration. Following extinction, however, reacquisition of ethanol self-administration was only impaired in the group where memantine was given after a short memory reactivation session, showing that this schedule of drug administration produced a long-lasting disruption of the association between the conditioned stimuli and the delivery of ethanol. In conclusion, we show that memantine disrupted the drug-cue association, which consequently interfered with relapse-like behaviour supporting the possibility that memantine is a treatment option for alcoholism. Our data supports the possibility that memantine is a treatment option for alcoholism. However, the effectiveness of this drug seems to lie in its ability to disrupt conditioned behaviours and should be given in conjunction with exposure to conditioned drug stimuli.

Role of ethanol-derived acetaldehyde in operant oral self-administration of ethanol in rats.

The role of ethanol-derived acetaldehyde has not been examined yet on performance in a model of operant oral self-administration. However, previous studies reported that an acetaldehyde-sequestering agent, D-penicillamine (DP) and an inhibitor of catalase-mediated acetaldehyde production, 3-amino-1,2,4-triazole (3-AT) reduce voluntary ethanol consumption. The aim of our investigation was to evaluate the effects of DP and 3-AT on acquisition and maintenance of oral operant ethanol self-administration. Using operant chambers, rats learned to nose poke in order to receive ethanol solution (5-10 % v/v) under an FR1 schedule of reinforcement in which discrete light and tone cues were presented during ethanol delivery. DP and 3-AT impair the acquisition of ethanol self-administration, whereas its maintenance is not affected neither by drug given alone for both 10 or 5 % ethanol nor by drugs association for 5 % ethanol. Moreover, when the concentration of ethanol was diminished from 10 to 5 %, rats increased the rate of self-administration behaviour. These findings suggest that brain acetaldehyde plays a critical role during acquisition of operant self-administration in ethanol-naïve rats. In contrast, during the maintenance phase, acetaldehyde could contribute to ethanol self-administration by a combined mechanism: On one hand, its lack (by DP or 3-AT) might result in further ethanol-seeking and taking and, on the other, inhibition of ethanol metabolism (by 3-AT) might release an action of the un-metabolised fraction of ethanol that does not overall result in compromising maintenance of ethanol self-administration.

Ethanol self-administration in mice under a second-order schedule

Long Fixed-Interval (FI) schedules, particularly second-order schedules, can engender substantial responding before drug or ethanol delivery that is uninfluenced by the direct effects of the drug or ethanol. Thus, these schedules can be used to study the effects of medications upon drug- or ethanol-seeking, uninfluenced by the direct effects of the self-administered drug or ethanol. Long FI second-order schedules are frequently used in primates and occasionally in rats. Under second-order schedules, completion of one response requirement, e.g., a Fixed Ratio 10 (FR10:S), produces a brief stimulus presentation, e.g., a 1-s 80-dB 4-kHZ tone, and this FR10:S serves as the response unit under another schedule, e.g., an FI 1800-s. Thus, the first FR10 completed after 1800 s would result in delivery both of the tone and of reinforcement, e.g., 10 × 0.01 mL 16% (w/v) ethanol. To examine if such schedules could be effectively used in mice, which have advantages in neurobiological and genetic studies, we trained eight C57BL/6J mice to respond under the schedule just described. This schedule maintained substantial responding. The temporal pattern of behavior was typical of an FI schedule with responding accelerating across the interval. We also examined the effects of acute and chronic administration of fluvoxamine on this responding, and these were modest. Finally, we examined responding when alcohol and/or tone deliveries were withheld, and found that extinction occurred most rapidly when both were withheld. This work demonstrates that long FI schedules of ethanol delivery may be useful in studying ethanol seeking in mice.

Reply to Norström (2014): The social epidemiology of alcohol and suicide—the struggle to formulate, debate and test social theory in the context of epidemiology and public health journals

Reply to <scp>N</scp>orström (2014): The social epidemiology of alcohol and suicide—the struggle to formulate, debate and test social theory in the context of epidemiology and public health journals

Build a better mouse model, and the world will beat a path to your door

Build a better mouse model, and the world will beat a path to your door

Unilateral inactivation of the basolateral amygdala attenuates context‐induced renewal of Pavlovian‐conditioned alcohol‐seeking

Environmental contexts associated with drug use promote craving in humans and drug-seeking in animals. We hypothesized that the basolateral amygdala (BLA) itself as well as serial connectivity between the BLA and nucleus accumbens core (NAC core) were required for context-induced renewal of Pavlovian-conditioned alcohol-seeking. Male Long-Evans rats were trained to discriminate between two conditioned stimuli (CS): a CS+ that was paired with ethanol (EtOH, 20%, v/v) delivery into a fluid port (0.2 mL/CS+, 3.2 mL per session) and a CS- that was not. Entries into the port during each CS were measured. Next, rats received extinction in a different context where both cues were presented without EtOH. At test, responding to the CS+ and CS- without EtOH was evaluated in the prior training context. Control subjects showed a selective increase in CS+ responding relative to extinction, indicative of renewal. This effect was blocked by pre-test, bilateral inactivation of the BLA using a solution of GABA receptor agonists (0.1 mm muscimol and 1.0 mm baclofen; M/B; 0.3 μL per side). Renewal was also attenuated following unilateral injections of M/B into the BLA, combined with either M/B, the dopamine D1 receptor antagonist SCH 23390 (0.6 μg per side) or saline infusion in the contralateral NAC core. Hence, unilateral BLA inactivation was sufficient to disrupt renewal, highlighting a critical role for functional activity in the BLA in enabling the reinstatement of alcohol-seeking driven by an alcohol context.

Lignocellulosic ethanol production from woody biomass: The impact of facility siting on competitiveness

Abstract Just as temperate region pulp and paper companies need to compete with Brazilian eucalyptus pulp producers, lignocellulosic biofuel producers in North America and Europe, in the absence of protectionist trade policies, will need to be competitive with tropical and sub-tropical biofuel producers. This work sought to determine the impact of lignocellulosic ethanol biorefinery siting on economic performance and minimum ethanol selling price (MESP) for both east and west coast North American fuel markets. Facility sites included the pine-dominated Pacific Northwest Interior, the mixed deciduous forest of Ontario and New York, and the Brazilian state of Espirito Santo. Feedstock scenarios included both plantation (poplar, willow, and eucalyptus, respectively) and managed forest harvest. Site specific variables in the techno-economic model included delivered feedstock cost, ethanol delivery cost, cost of capital, construction cost, labour cost, electricity revenues (and co-product credits), and taxes, insurance, and permits. Despite the long shipping distance from Brazil to North American east and west coast markets, the MESP for Brazilian-produced eucalyptus lignocellulosic ethanol, modelled at $0.74 L−1, was notably lower than that of all North American-produced cases at $0.83–1.02 L−1.

Targeted PDT and its clinical relevance

Venous ethanol infusion via an occlusive balloon has been used as a bailout approach to treat ablation-refractory ventricular arrhythmias (VAs). Unfavorable venous anatomy (lack of intramural veins at the targeted site or collateral vein–ethanol shunting) limits its efficacy. Blocking collateral flow with a second balloon may optimize myocardial ethanol delivery.The purpose of this study was to validate the “double-balloon” approach to enhance ethanol delivery in cases of unfavorable venous anatomy.Eight patients referred after failed ablations (3 left ventricular [LV] summit, 5 scar-related ventricular tachycardia) underwent endocardial mapping and additional radiofrequency ablation without VA resolution. Coronary veins were mapped using a multipolar catheter or wire, and selective venograms were obtained. The double balloon was used when (1) distal collateral branches shunted flow away from the targeted region; (2) the target vein had optimal signals only proximally; or (3) a large vein was targeted that had multiple branches for a large area of interest.Acute successful ethanol infusion myocardial delivery and resolution of VA was accomplished using the posterolateral LV veins (n = 2 patients, 3 procedures), lateral LV vein (n = 1), apical anterior interventricular vein (AIV; n = 1), middle cardiac vein (n = 1), and septal branches of the AIV (n = 3). At median follow-up of 313.5 days, 2 patients experienced recurrence.The double-balloon technique can enhance ethanol delivery to target isolated vein segments, block collateral flow, or target extensive areas, and can expand the utility of venous ethanol for treatment of VAs.