Transcoronary chemical ablation of tachycardias

Abstract

Cardiac arrhythmias can be successfully controlled nowadays in a remarkable percentage of patients. We have at our disposal new antiarrhythmic drugs with high efficacy and acceptable side-effect profiles [1]. Selected patients with selected arrhythmias not controllable with antiarrhythmic drugs [2] can be treated with electrical devices. Refined surgical techniques for the treatment of supraventricular [3–4] and ventricular arrhythmias [5–6] are available. The implantable defibrillator has become a reality [7]. Percutaneous electrical ablation is effective to create atrio-ventricular block in patients with atrial fibrillation with uncontrollable rapid ventricular rates [8]. Unfortunately, we are still far from controlling cardiac arrhythmias in all patients. Not all respond to antiarrhythmic drugs. Many are not amenable to antitachycardia pacing or control by an implantable defibrillator. Because of the important myocardial damage present in many patients surgery for ventricular tachycardia has a high perioperative mortality. Percutaneous electrical ablation of accessory pathways is still experimental and electrical ablation of ventricular tachycardia [9] has not offered the expected results [10].This technique creates lesions with a small size. Extensive myocardial damage can result when multiple shocks are given. However, surgery and percutaneous electrical ablation are forms of treatment that can destroy or remove the arrhythmia substrate, offering a definitive cure when successful. Antiarrhythmic drugs and electrical devices are palliative therapies. Techniques able to destroy the arrhythmia substrate overcoming the problems of percutaneous electrical ablation and surgery would represent an important addition to our antiarrhythmic armentarium.