Transvenous ethanol ablation in epicardial localization of ventricular arrhythmias: a case report

BACKGROUND : An endocardial radiofrequency ablation is a common approach for the treatment of idiopathic ventricular arrhythmia. However, rare cases have been reported in which ventricular arrhythmia could not be ablated from endocardium due to an epicardial origin of the arrhythmia. CASE SUMMARY : In this article, we describe the rarely used, but acceptable approach to terminate ventricular arrhythmias in the summit of the left ventricle. We present a case of a 56-year-old patient with sustained monomorphic premature ventricular complexes, originating from the summit of the left ventricle, that were successfully eliminated. After unsuccessful ablation of the anterior wall right ventricular outflow tract, left coronary cusp, and distal coronary sinus, arrhythmia was eliminated by method of transvenous ethanol ablation. Complaints, such as palpitations and weakness, resolved after the procedure. DISCUSSION : This approach is used when an epicardial location of the substrate of arrhythmia is suspected and ablation through the right ventricular outflow tract, left coronary cusp, and great cardiac vein fails. The total effectiveness of eliminating ventricular arrhythmia increases if it is possible to use endo- and epicardial methods of mapping and ablation. In clinics with extensive experience in this area, ethanol ablation of epicardial ventricular arrhythmia is safe and effective.