Presented at the 2013 AAPM Annual Meeting « Back

Case Report: Benefits of Continuous Left Stellate Ganglion Blockade for the Management of Electrical Storm

David F. Hulata, MD, dhulata@gmail.com¹, Linda T. Le-Wendling, MD², Matthew Johnson, MD³, Andre P. Boezaart, MD PhD¹, (1) Shands University of Florida, Gainesville, Florida, (2) University of Florida College of Medicine, Gainesville, Florida, (3) University of Florida Department of Anesthesiology, Gainesville, Florida

Introduction: Electrical storm (ES) is a syndrome characterized by recurrent ventricular fibrillation or tachycardia. ES is a major clinical challenge often unresponsive to conventional drug therapy requiring multiple defibrillations. The sympathetic nervous system plays a significant role in the genesis of these life-threatening arrhythmias.5 Left stellate ganglion blockade (LSGB) has been shown to rapidly stabilize ES and improve the mortality rate.1-4 We present a case report of a patient with ES that was rapidly stabilized after LSGB. Description: A 60-year-old male with history of ischemic cardiomyopathy was transferred for ES after placement of an ICD. He received standard antiarrhythmics, overdrive pacing, ATP therapy, and dozens of defibrillations in attempts to terminate the unstable ventricular tachycardia. Despite lead revision and ablation the patient continued to have multiple episodes of unstable sustained VT only responsive to pacing and defibrillation. The acute pain service placed a catheter underneath the lateral prevertebral fascia at the level of C7 using an in-plane ultrasound-guided approach. After a negative test dose and confirmation of spread we started an infusion of 0.2% ropivacaine at 5 ml/hr. Afterward the patient experienced only nonsustained VT that continued to improve with increased infusion rate to 8ml/hr. Six days later the chronic pain service performed a successful neurolytic stellate ganglion block using the in situ catheter. Discussion: Sympathetic hyperactivity is an important modulator of ventricular arrhythmias including ES. Ultrasound-guided continuous LSGB is a safe, quick, and semi-permanent procedure that decreases the frequency and duration of ventricular tachycardia prior to neurolytic blockade. References: 1) Bourke T, Vaseghi M, Michowitz Y, et al. Neuraxial modulation for a refractory ventricular arrhythmias: value of thoracic epidural anesthesia and surgical left cardiac sympathetic denervation. Circulation. 2010; 121: 2255-2262. 2) Loyalka P, Hariharan Ramesh, Gholkar G, et al. Left stellate ganglion block for continuous ventricular arrhythmias. Texas Heart Institute Journal. 2011; 38: 409-11. 3) Nademanee K, Taylor R, Bailey WE, Rieders DE, Kosar EM. Treating electrical storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Circulation. 2000; 102: 742-747. 4) Patel RA, Priore DL, Szeto WY, Slevin KA. Left stellate ganglion blockade for the management of drug-resistant electrical storm. Pain Medicine. 2011; 12: 1196-1198. 5) Schwartz PJ. The rationale and the role of left stellectomy for the prevention of malignant arrhythmias. Annals New York Academy of Sciences. 1984; 427: 199-221.

Funding: None