Intramyocardial Ethanol Injection
When VT was reinduced after surgical ablation, ethanol injection would be attempted (Figure 3). The sites of injection were around the RF lesions (Table 2). A mean of 2.3±0.6ml ethanol was injected for each patient. During injection, accelerated idioventricular rhythm or non-sustained VTs were noticed in 2 patients (Pt-1 and -5), which might be an acute reaction of the myocardium to alcohol. Interestingly, VT could be reinduced again after surgical RF ablation and ethanol injection. After activation mapping, the earliest site was localized close to the left circumflex coronary artery (<1cm). Surgical ablation was not considered and local epicardial fat tissue was removed. With one dosage of 0.3 ml ethanol injection in this specific site, VT was terminated immediately (Figure 5). In addition to surgical RF ablation and ethanol injection, concomitant surgical procedures were performed in 3 patients (Figure 3).