Ultrasound-Guided Left Stellate Ganglion Blocks for Recurrent Ventricular Tachycardia (Electrical Storm)

Abstract

Recurrent Ventricular Tachycardia, or Electrical Storm, is a relatively common cause of mortality and morbidity after myocardial infarction. We present a case in which left stellate ganglion blocks were performed under ultrasound guidance in order to alleviate recurrent ventricular tachycardia in a patient requiring extracorpeal membrane oxygenation after myocardial infarction. A medically complex 54-year-old male after two weeks removed from an acute ST elevation myocardial infarction status post stenting and intra-aortic balloon pump placement presented in the cardiovascular intensive care unit with recurrent unstable ventricular tachycardia while on extracorporeal membrane oxygenation and multiple vasoactive infusions. Our acute pain service was consulted by the cardiac electrophysiology service to provide left stellate ganglion blocks in attempt to attenuate electrical storm. Multiple single shot left stellate ganglion blocks were performed on subsequent days with increasing local anesthetic concentrations and volumes successfully providing temporary relief of electrical storm. A left stellate ganglion catheter was eventually placed, and a continuous infusion of local anesthesia was started. The patient experienced complete relief from unstable ventricular tachycardia and no further defibrillations were required. The catheter remained in place for 14 days allowing for extracorporeal membrane oxygenation decannulation without the return of electrical storm. We believe ultrasound guided left stellate ganglion blocks to be a relatively safe means to provide temporary relief of recurrent ventricular tachycardia.