Stellate ganglion blockade for electrical storm: a case report

Abstract

Introduction The Chronic Chagasic Cardiomyopathy is one important cause of arrhythmias in Brazil. The usual anti-arrhythmic treatment involves the use of medication, placement of implantable cardioverter defibrillator (ICD) and catheter ablation therapy. Some patients with ICD develop electrical storms (ES), 3 or more episodes of ventricular arrhythmia followed by electrical therapy in 24h. Under these circumstances is believed that the sympathetic tone is heightened. There has been a growing evidence showing that the modulation of neural activity with the Stellate Ganglion Blockade (SGB) can be an adjuvant treatment for patients with ES. Methods Case Report: A 50-year-old male patient with medical history of arrhythmogenic chagasic cardiomyopathy with previous ICD presented several episodes of chest pain, dizziness and Sustained Ventricular Tachycardia frequently leading him to the emergency room (ER). After cardioversion from the ICD and drug optimization he presented better control of the arrhythmia. A month later, a new episode of chest pain, dyspnea, abdominal pain, Sustained Ventricular Tachycardia with a heart rate of 130bpm - below the ICD trigger – brought him to the ER again. In addition to the pharmacological therapy, the stellate ganglion blockade was chosen (SGB). It was performed in sterile conditions and ultrasound-guided. From cricoid cartilage, the probe was moved caudad and laterally to visualize C7’s transverse process. We used a Quincke 22G needle to perform the SG . The tip of the needle was placed on the anterior fascia of the longus coli muscle. Through ultrasound imaging the dispersion of the 10ml of anesthetic solution with lidocaine 1% and bupivacaine 0,25% was seen throughout the stellate ganglion pathway. Results Procedure was performed without any complications.On the 24-hour follow up the patient presented a slow ventricular tachycardia, treated with ATP and sent to cardiac ablation, with satisfactory outcome. Discussion Conclusion: The SGB can be a bedside and efficient option as a treatment for ES, it improves cardiac autonomic modulation decreasing the occurrence of ES and can be used as a bridge for cardiac ablation.