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).