Dec. 25, 2012 -- A cardiologist in England gained international attention when he used an unconventional procedure -- a shot of basic alcohol to the heart -- to stop an unusual cardio rhythm in an elderly patient.
Dr. Tom Johnson, who carried out the procedure at the Bristol Heart Institute Hospital in Bristol, England, said Ronald Aldom, 77, was doing "fantastically well" after Johnson and his team used pure ethanol to treat Aldom's rapid heartbeat, a condition called ventricular tachycardia, or VT, about six weeks ago. VT, which starts in the lower two chambers of the heart -- the ventricles -- can be life-threatening if it goes untreated.
"He's got a lot of life to live," Johnson said.
It may seem like a story lifted out of "Pulp Fiction," but treating VT with ethanol, though rare, is an accepted method that has been used for years. What was noteworthy about Johnson's procedure was that he had never used ethanol to treat VT before, nor had it ever been done in that part of the United Kingdom.
"[Aldom] was at a point where he felt he had no other option and was kind of facing death," Johnson said. "While it sounds like a very barbaric treatment, it was a very rewarding one, [but] very high risk."
Typically, a radio frequency catheter ablation is the treatment choice for someone with VT. A radio frequency catheter is an electrical probe that is threaded into the heart and uses low-voltage electricity to kill the heart tissue around the area causing the arrhythmia. This prevents the tissue from continuing to produce the abnormal rhythm.
But Johnson said his colleagues had already tried that technique on Aldom, who had also previously endured heart attacks, without success -- scar tissue that forms after heart attacks can reject the electrical treatment.
"It was complicated by the fact that [Aldom] had severe damage to his heart already," Johnson said. "It got to the point where this poor man was like, 'please shut it off and let me die.'"
Ethanol ablation works in the same way in that it also selectively destroys heart tissue, but it is more commonly used to treat hypertrophic cardiomyopathy, a condition in which the heart muscle is thick or "bulky," Johnson said. While he had used ethanol to treat hypertrophic cardiomyopathy before, to use it on Aldom was a last resort.
"This guy had no other option, which is why we were able to do something we had never done before," Johnson said.
The first step, Johnson said, was for him and his team to electronically map the heart to find and isolate the tissue that was causing the abnormal rhythm. Once the problem artery was located, Johnson's team fed a wire into the vein graph and inflated a balloon to block the artery. Through that balloon, Johnson said they injected the ethanol while the patient was under anesthetic, killing off the problem tissue.
Destroying the tissue creates a controlled, "selective" heart attack, which can be painful, Johnson said, but it allows the heartbeat to return to normal.
Using ethanol can have risky complications, Johnson said, because not only does it kill tissue, it can also kill some of the electrical function of the heart -- Aldom was already using a pace maker. Another risk, Johnson said, was that the balloon could shift, killing more tissue than intended. But his procedure came through successfully.
Dr. Richard Page, the chairman of the department of medicine at the University of Wisconsin School of Medicine and Public Health and a past-president of the Heart Rhythm Society in the United States, agreed that using ethanol to treat VT was "not a routine procedure at all."
While he didn't condemn Johnson's decision to use an ethanol injection, Page said the procedure can be "difficult to control" and a "spillover" could cause "more damage than you intended or needed," meaning it could lead to a slightly greater selective heart attack.
"This is something you have to do electively," Page said. "This is not something you do on the fly in the middle of a cardiac arrest."
Johnson said using the radio frequency method would remain his first line of defense in treating VT, and the ethanol method would be an "adjunct" to that. However, he also said that he and his colleagues treat around 70 patients a year with the potentially fatal VT condition -- and on Christmas Eve alone, Johnson said he had treated eight emergency heart attack cases -- so the ethanol treatment could be used more frequently in the future.
"In our center, we're treating several hundred heart attack cases a year, so unfortunately, we're going to see more patients presenting with unstable heart conditions, so the fact that these treatments could be more common is a potential reality," he said.