Stellate ganglion block therapy in management of ventricular electrical storm: A case report

Abstract

Sympathetic overactivity is a recognized underlying mechanism contributing to the pathogenesis of ventricular electrical storm (VES). The growing body of evidence supports the efficacy of stellate ganglion block (SGB) in attenuating myocardial sympathetic tone, rendering it a valuable adjunctive therapy for managing VES. This case report presents the clinical details of a 60-year-old patient admitted for ventricular tachycardia (VT), necessitating the implantation of an implantable cardioverter defibrillator (ICD) to mitigate the risk of fatal ventricular arrhythmias (VAs). Subsequently, the patient received repeated antitachycardia pacing (ATP) therapy due to persistent symptomatic VT episodes. SGB was contemplated due to the patient's hemodynamic instability during episodes of VT and the ineffectiveness of pharmacotherapy. Initially, complete suppression of VT was achieved for 3 days using local anesthesia, followed by partial suppression via pulsed radiofrequency (PRF), culminating in sustained relief for 3 months following continuous radiofrequency (CRF) therapy. Different methods of SGB elicited varied responses in this patient. CRF appeared to be more effective than PRF and conventional local anesthetics. CRF ablation of the stellate ganglion for refractory VAs offers a potential therapeutic option.

Keywords

• Ventricular electrical storm
• Stellate ganglion block
• Pulsed radiofrequency
• Continuous radiofrequency
• Case report