DISCUSSION
Catheter ablation is a very effective and demanding technique in the
treatment for cardiomyopathy patients with VT storms, especially those
with frequent ICD shocks. However, those who were failed by combined
endocardial and epicardial ablation are a unique population with very
high mortality. Searching for solutions to control VTs in such tough
patients is rather important. We report our experience of direct RF
ablation with intramyocardial ethanol injection via surgical approach to
treat the patients with recurrent VT despite multiple endocardial and/or
epicardial ablations. The key findings of this study are as follows: (1)
in some patients with non-ischemic cardiomyopathy, VTs were of true
intramural origin which explain their refractory property to both
endocardial and epicardial ablation (Supplementary Figure 2); (2)
surgical RF ablation allowed manual pressure of the catheter against the
epicardium, yielding more effective lesions than percutaneous epicardial
ablation; (3) intramural ethanol injection produced homogenized tissue
necrosis and was a safe and effective strategy for VT elimination.