A Comparative Study of Intracoronary Iced Saline Versus Intracoronary Antiarrhythmic Drugs to Identify the Ventricular Tachycardia‐Related Artery

Identifying the Tachycardia-Related Coronary Artery. Introduction: Transcatheter chemical ablation is a new treatment option for patients with ventricular tachycardia. Availability of a safe, simple, and sensitive method to identify the ventricular tachycardia-related artery is required for successful intracoronary chemical ablation for ventricular tachycardia. The purpose of this study was to compare bolus intracoronary iced saline injection to bolus intracoronary antiarrhythmic drug injection as methods for identifying the ventricular tachycardia-related coronary artery. Methods and Results: Patient selection was limited to eight individuals with recurrent sustained monomorphic ventricular tachycardia, coronary artery disease, remote myocardial infarction, and in whom programmed stimulation could reproducihiy induce the clinical arrhythmia. An infusion catheter was positioned in the putative ventricular tachycardia-related artery and ventricular tachycardia was provoked hy programmed stimulation. In four patients the putative ventricular tachycardia-related artery was a patent infarct-related vessel and in the other four patients was a vessel supplying collateral flow to an occluded infarct-related artery. The effects of selective intracoronary iced saline bolus injection (10 mL), and then of selective intracoronary bolus antiarrhythmic drug injection (2.5 mg lidocaine in one patient, procainamide 1.0–9.0 mg in seven patients) were observed. Bolus intracoronary iced saline injection did not alter ventricular tachycardia in any patient. Bolus intracoronary antiarrhythmic drug injection, however, led to ventricular tachycardia cycle length prolongation in two patients and arrhythmia termination in four patients. In two of these individuals, infusion of ethanol into the tachycardia-related vessel previously identified by intracoronary drug injection resulted in ablation of the ventricular tachycardia. Conclusions: In the present study, selective intracoronary antiarrhythmic drug injection appeared to be more effective than intracoronary iced saline for identifying the ventricular Uchycardia-related coronary artery, (J Cardiovasc Electrophysiol, Vol. 3, pp. 199–208 June 1992)