Weathering the storm: Combining microaxial left ventricular assist device support with bilateral stellate ganglion blockade to treat recalcitrant ventricular tachycardia

Abstract

We present a case of a 45-year-old female with advanced heart failure due to nonischemic cardiomyopathy, an ejection fraction of 15% complicated by ventricular arrhythmias degenerating into an electrical storm. The treatment approach involved antiarrhythmic medications, inotrope support, diuretics, and the placement of an Impella 5.5 device for mechanical circulatory support. Due to persistent polymorphic ventricular tachycardia, a bilateral stellate ganglion blockade was performed along with intensified antiarrhythmic therapy and deep sedation. This case highlights the role of axillary mechanical circulatory support with the Impella 5.5 in providing unfettered hemodynamic stability and the potential added benefit of stellate ganglion blockade in managing malignant ventricular arrhythmias.

Keywords

• heart failure
• cardiogenic shock
• electrical storm
• Torsades de Pointes
• Impella 5.5
• stellate ganglion blockade