DP32: STELLATE GANGLION BLOCK FOR REFRACTORY VENTRICULAR ARRHYTHMIAS IN THE CRITICAL CARE SETTING
Prahar Shah, MD; Ojas Chinchwadkar, MD; David Habibian, MD; Rachel Choron, MD; William Grubb, MD, DDS
Rutgers - Robert Wood Johnson
Introduction: Stellate ganglion block (SGB), while traditionally utilized for sympathetic-mediated symptoms and pain such as in Complex Regional Pain Syndrome, has emerged as a promising intervention for managing refractory ventricular arrhythmia[1]. This case demonstrates the efficacy of SGB in a patient with persistent ventricular tachycardia/ventricular fibrillation (VT/VF) following left heart catheterization (LHC) with percutaneous coronary intervention (PCI). Here, we present a case of utilization of SGB for recurrent VT/VF in the critical care setting.
Case/Methods: A 58-year-old male with a history of obesity and type II Diabetes Mellitus presented to the emergency department 2 weeks after a new diagnosis of COVID-19 status-post 1-week treatment with Paxlovid with persistent shortness of breath and retrosternal chest pain. He was found to have signs of myocardial infarction on electrocardiogram and a LHC revealed multivessel disease and subsequently underwent PCI with drug-eluting stent placement in the proximal left anterior descending and left circumflex arteries. LHC and PCI was complicated by multiple episodes of ventricular tachycardia/ventricular fibrillation arrests, cardiogenic shock, requiring Impella placement and eventual VA-ECMO cannulation. Patient had persistent VT/VF arrests that did not improve with Impella explantation or anti-arrhythmic therapy with amiodarone, lidocaine, procainamide, esmolol. An ultrasound-guided right-sided SGB was performed using 8 mL of 0.25% bupivacaine utilizing a 22-gauge 4-inch spinal needle with a transverse view of the neck via a lateral in-plane approach, injecting inferior to the carotid body [Figure 1].
Results: Following the procedure, the VT/VF episodes ceased, allowing for down-titration of antiarrhythmic medications over the subsequent three days. The patient was then maintained on amiodarone and subsequently had no recurrence of arrhythmias for 14 days after which the patient received an implantable cardioverter-defibrillator (ICD) prior to discharge.
Conclusion: This case demonstrates the potential of SGB as an effective rescue therapy for ventricular arrhythmias refractory to anti-arrhythmic therapy in a critically ill patient that was on VA-ECMO. SGB facilitated the resolution of persistent VT/VF, enabling weaning from mechanical circulatory support and antiarrhythmic medications. Our findings align with recent literature supporting SGB use for ventricular arrhythmias[2].
References:
[1] Feigin, Guy, et al. "Stellate ganglion block for non-pain indications: a scoping review." Pain Medicine 24.7 (2023): 775-781.
[2] Chouairi, Fouad, et al. "A multicenter study of stellate ganglion block as a temporizing treatment for refractory ventricular arrhythmias." Clinical Electrophysiology 10.4 (2024): 750-758.