PO-04-185 SAFETY AND EFFICACY OF BEDSIDE ULTRASOUND-GUIDED SYMPATHETIC BLOCKADE BY PROXIMAL INTERCOSTAL BLOCK IN PATIENTS WITH ELECTRICAL STORM

Abstract

Electrical storm (ES) patients (pts) who fail standard therapies have a high mortality rate. Previous studies report effective management of ES with bedside, ultrasound-guided percutaneous stellate ganglion block (SGB) as single injection or continuous infusion of local anesthetics. SGB can be technically challenging by the presence of other catheters and support devices in the anatomical area. We report our experience with sympathetic blockade administered by the regional anesthesiology team via the alternative proximal intercostal block (PICB) (Figure 1A-C). This technique targets an area typically free of catheters and support devices, and may pose less strict requirements for anticoagulation interruption, along with lower risk of focal neurologic side effects. To describe safety and efficacy of PICB in patients with refractory ES. We reviewed our institutional data on ES pts who underwent PICB between 1/2019-10/2022 to analyze procedural safety, short and long-term outcome. Total of 12 pts with ES underwent PICB during this period (Table 1). Five pts initially had left SGB, but 2/5 required PICB due to need for prolonged infusion and rotating site of infusion catheter. Three pts underwent PICB due to lack of efficacy of SGB alone. Sympathetic blockade efficacy appeared higher when left SGB was combined with PICB with response rate of 71.4%. Among ten pts who presented with recurrent ICD shocks (Figure 1D), nine had no further ICD shock after PICB until discharge, heart transplant, or death (P=0.01). There was no procedure-related complication or focal neurologic symptoms. Overall, 8 (66.7%) pts had VT ablation, 9 (75%) pts survived to discharge, 2 (16.7%) pts underwent heart transplantation, 1 (8.4%) patient had ventricular assist device implanted as a bridge to transplant, and 2 (16.7%) pts died. During median of 168 +/- 148.5 days follow up on those pts who survived to discharge without heart transplant, 71.4% remain free of any VT recurrence. In patients with refractory ES, continuous PICB provided safe and effective sympathetic block with no incidence of block-related focal neurologic symptoms. In our series, overall PICB efficacy was 66.7% and the combination of PICB and left SGB appeared complementary. The potential benefits of bilateral sympathetic blocks or block combinations should be carefully weighed against patient- and technique-specific risks and side effects. Larger studies are needed to compare these treatment techniques.