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| 22KS-004 |
Stellate ganglion block for ventricular electrical strom : A Case report
Department of Anesthesiology and Pain Medicine, Inha
University Hospital, Inha university School of Medicine
Introduction
Increased cardiac sympathetic activity is thought to cause a ventricular electrical storm(VES). Although VES may be treated with successful catheter ablation, it may be difficult to implement in hemodynamically unstable patients.
Stellate Ganglion Block (SGB) is minimally invasive technique for controlling VES through temporary sympathetic cessation.
We introduce the case of a patient with VES which was controlled by SGB.
Case report
The patient is a 59-year-old man with a history of hypertension and hyperlipidemia. He came to the emergency room for chest pain. There was STEMI in electrocardiogram, so coronary angiography with b was performed and then admitted to intensive care unit. In addition, drug eluting stent to the proximal left anterior descending coronary artery and implantable cardioverter defibrillator implantation were performed, however, VES persisted (Fig. 1). And then our pain clinic was consulted for transient sympathetic blockade .
Three times of SGB had performed three days in a row. It was first performed on the left SGB. The patient was placed in the supine position by supporting a small pillow on his shoulder. Ultrasound guided needle insertion to the longus coli muscle above the C7 transverse process and 1% mepivacaine 6cc was injected. The next day, the second SGB was performed on the right side and finally, on the left side in the same way.
Following for a week, the VT episode did not occur and he was transferred to the general ward (Fig. 2).
During his hospitalization, an incidental left renal mass was found in the chest CT. Then, laparoscopic radical nephrectomy was planned. To prevent stress-induced VES, left SGB was performed before general anesthesia and the operation was performed with the ICD stopped. There was no event of ventricular arrhythmias and the patient’s vital sign was remained stable. The operation was successfully done and he also has recovered well.
Conclusion
SGB is safe and effective for the treatment of patients with VES.
References
1. Ganesh A, Qadri YJ, Boortz-Marx RL, Al-Khatib SM, et al. Stellate Ganglion Blockade: an Intervention for the Management of Ventricular Arrhythmias. Curr Hypertens Rep. 2020;22(12):100.
2. Meng L, Tseng CH, Shivkumar K, Ajijola O. Efficacy of Stellate Ganglion Blockade in Managing Electrical Storm: A Systematic Review. JACC Clin electrophysiol. 2017;3(9):942-9
Increased cardiac sympathetic activity is thought to cause a ventricular electrical storm(VES). Although VES may be treated with successful catheter ablation, it may be difficult to implement in hemodynamically unstable patients.
Stellate Ganglion Block (SGB) is minimally invasive technique for controlling VES through temporary sympathetic cessation.
We introduce the case of a patient with VES which was controlled by SGB.
Case report
The patient is a 59-year-old man with a history of hypertension and hyperlipidemia. He came to the emergency room for chest pain. There was STEMI in electrocardiogram, so coronary angiography with b was performed and then admitted to intensive care unit. In addition, drug eluting stent to the proximal left anterior descending coronary artery and implantable cardioverter defibrillator implantation were performed, however, VES persisted (Fig. 1). And then our pain clinic was consulted for transient sympathetic blockade .
Three times of SGB had performed three days in a row. It was first performed on the left SGB. The patient was placed in the supine position by supporting a small pillow on his shoulder. Ultrasound guided needle insertion to the longus coli muscle above the C7 transverse process and 1% mepivacaine 6cc was injected. The next day, the second SGB was performed on the right side and finally, on the left side in the same way.
Following for a week, the VT episode did not occur and he was transferred to the general ward (Fig. 2).
During his hospitalization, an incidental left renal mass was found in the chest CT. Then, laparoscopic radical nephrectomy was planned. To prevent stress-induced VES, left SGB was performed before general anesthesia and the operation was performed with the ICD stopped. There was no event of ventricular arrhythmias and the patient’s vital sign was remained stable. The operation was successfully done and he also has recovered well.
Conclusion
SGB is safe and effective for the treatment of patients with VES.
References
1. Ganesh A, Qadri YJ, Boortz-Marx RL, Al-Khatib SM, et al. Stellate Ganglion Blockade: an Intervention for the Management of Ventricular Arrhythmias. Curr Hypertens Rep. 2020;22(12):100.
2. Meng L, Tseng CH, Shivkumar K, Ajijola O. Efficacy of Stellate Ganglion Blockade in Managing Electrical Storm: A Systematic Review. JACC Clin electrophysiol. 2017;3(9):942-9
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