B-PO05-168 BEDSIDE PERCUTANEOUS SYMPATHETIC BLOCK IS SAFE AND EFFECTIVE IN REFRACTORY ELECTRICAL STORM AS A BRIDGE TO ADVANCED THERAPIES

Abstract

Patients with electrical storm (ES) who fail standard medical and interventional therapies have a high mortality rate and are difficult to bridge to definitive therapies. Bedside, ultrasound-guided percutaneous sympathetic block (PSB) can stabilize these patients in the acute setting. To describe the outcomes of patients with electrical storm (ES), in whom PSB was used to bridge them to advanced therapies. Retrospective study of consecutive ES patients undergoing bedside ultrasound-guided PSB between 1/2017-3/2020 at our institution. Of the 19 PSB patients in ES, the majority were male (89.5%) with average age of 66.5±6.0 years and left ventricular ejection fraction (LVEF) 28± 10%. There was underlying ischemic cardiomyopathy in 52%. Catheter ablation was performed in 47.3% prior to PSB with average 1.1±1.4 ablations with 2.5±0.48 adjunctive anti-arrhythmia medications. The ventricular arrhythmia (VA) was monomorphic in 70% with cycle length 250-490ms. Despite intubation and mechanical ventilation in 47% of these patients, the majority were in ES (94%) the day of procedure. After PSB, no ventricular arrhythmia recurred in eight patients (42%). There was a significant decrease in amount of VA (4.4±2.5 vs. 2.2± 3.5 episodes P= 0.019) and number of patients with ES the day before and after procedure 18 vs. 16 patients P=0.00001. Minor reversible side effects were noted in 21% and no significant bleeding was reported despite all patients being on anticoagulants or antiplatelet agents. Follow up was 4.5±5 months: 5 patients died, one referred to hospice, 5 had heart transplant and 3 underwent surgical sympathetic denervation. Four patients underwent coronary revascularization, 2 were treated with immunosuppression, 2 underwent stereotactic body radiation therapy, 1 surgical cryoablation, one AAI pacing, 2 LVAD and 1 needle catheter ablation. Fifteen patients survived admission and 13 (86%) were free of any arrhythmia during follow up. PSB with continue infusion is a safe and effective beside procedure in patients who have exhausted conventional therapy and can offer a rescue bridge to facilitate advanced treatments.