The Annals of Thoracic Surgery, Vol 57, 203-207, Copyright © 1994 by The Society of Thoracic Surgeons
Potential ablation of accessory atrioventricular pathways: injection of alcohol into the atrioventricular groove
LL Creswell, M Rosenbloom, JS Pirolo, JE Saffitz and JL Cox
Department of Surgery, Barnes Hospital, Washington University School of Medicine, St. Louis, Missouri 63110.
Accessory atrioventricular (AV) pathways responsible for the Wolff-
Parkinson-White syndrome have been treated successfully by surgical and
radiofrequency catheter ablation techniques. In this study, we explored the
feasibility of permanent chemical ablation of accessory pathways by direct
injection of 100% ethanol into the canine AV groove. Right coronary artery
blood flow and AV compartment pressure were measured in 5 adult mongrel
dogs (part I) during injection of saline solution (10 to 15 mL) into the
right AV groove. Atrioventricular groove compartment pressure increased
from 1 +/- 1 to 31 +/- 12 mm Hg (p < 0.0001) and right coronary artery
blood flow increased slightly from 117 +/- 17 to 138 +/- 44 mL/min (p = not
significant). In 8 additional dogs (part II), 100% ethanol (10 mL) was
injected into the left AV groove. After 6 weeks (n = 6) or 12 weeks (n =
2), histologic examination of the left AV groove demonstrated localized
fibrous replacement of injured epicardial muscle, with only scant
inflammatory infiltrate. Mild intimal fibrosis and intimal proliferation
were present in the circumflex artery and its larger branches, but no
significant luminal narrowing was evident. Angiograms at 12 weeks (n = 2)
demonstrated no significant narrowing of the circumflex artery. In summary,
injection of 100% ethanol into the AV groove is capable of locally ablating
myocardial tissue, presumably including conductive tissues, while sparing
the coronary arteries.
