Emergent Phenol Injection of Bilateral Stellate Ganglion for Management of Refractory Malignant Ventricular Arrhythmias.

Abstract

Case seriesPatients: Male, 51-year-old • Male, 59-year-oldFinal Diagnosis: Ventricular tachycardia (VT)Symptoms: Cardiac arrestMedication: —Clinical Procedure: AblationSpecialty: Critical Care MedicineObjective:Unusual or unexpected effect of treatmentBackground:Management of incessant electrical storm is poorly defined. These 2 case studies demonstrate a simplified percutaneous approach to achieve stellate ganglion ablation (SGA) and to promptly control malignant ventricular arrhythmias.Case Reports:This report describes 2 patients with deteriorating hemodynamics, progressive ventricular arrhythmias, and worsening heart failure, managed with emergent percutaneous fluoroscopically-guided bilateral SGA to achieve bilateral cardiac sympathetic denervation. While supine and intubated, the left and then right stellate ganglion were identified guided by anatomic landmarks. Using a 22-guage, 3.5-inch spinal needle, contrast dye was injected with appropriate outline of the stellate ganglion at the uncinate process of the C6 vertebra. Bupivacaine 0.5% was injected, followed by phenol 6%. Successful SGA was confirmed by intentional Horner’s syndrome with bilateral eye lag. The procedures were completed in about 30 min without complications and there was a dramatic reduction in ventricular arrhythmias.Conclusions:Emergent percutaneous bilateral SGA can be accomplished with a brief procedure resulting in management of electrical storm.