Trial Ultrasound-Guided Continuous Left Stellate Ganglion Blockade Before Surgical Gangliolysis in a Patient with a Left Ventricular Assist Device and Intractable Ventricular Tachycardia

Abstract

Stellate ganglion blockade for cardiac dysrhythmia is a well-described technique but infrequently used to manage ventricular tachycardia (VT). In patients with left ventricular assist devices (LVADs), these dysrhythmias cause increased morbidity because of right ventricular dysfunction, and often severe discomfort. Continuous stellate ganglion blockade may yield valuable information on a diagnostic and therapeutic basis in preparation for definitive, permanent interventions. We describe the successful management of intractable VT with continuous left stellate ganglion blockade, followed by surgical gangliolysis in a patient with an LVAD.

Massive myocardial edema and inflow cannula obstruction due to epicardial surgical ventricular tachycardia cryoablation at time of left ventricular assist device implantation

“…In cases such as this, SGB can be a useful option as a bridge to either resolution of VT from a low cardiac output state or more definitive therapy once clinically stable. Previously there have been concerns about the need to cease anticoagulation to perform this procedure, but our case adds to the literature 9 , 10 that demonstrates it can be effectively and safely performed at the bedside without cessation of therapy.…”

Autonomic Modulation for the Treatment of Ventricular Arrhythmias: Therapeutic Use of Percutaneous Stellate Ganglion Blocks

“…The use of a percutaneous stellate ganglion block as a therapeutic intervention in patients with electrical storm have been reported in selected single case reports and were reported to last for up to several weeks . Sympathetic nerve modulation in patients with LAVDs have also been reported . Stellate ganglion blocks have even been used on a recurrent basis (biweekly) as a palliative measure in a patient without any long‐term options .…”

Sympathetic Blockade for Dysrhythmia Management in Heart Failure: Rationale and Therapeutic Progression to Intervention

“…An intervascular approach between the left carotid artery and the left internal jugular vein may be used if dictated by anatomical restrictions (Figure 3). A continuous infusion of 1 mL per hour of 1% preservative free lidocaine may be initiated [93].…”

“…At the time of this writing there are five case reports or case series in the recent literature, which address successful use of LCSD accomplished via somewhat different methods to treatment recurrent VT and electrical Ultrasound of left stellate ganglion (SG) block using the intervascular approach between carotid area (CA) and internal jugular (IJ) vein is shown. VA is vertebral artery; dashed red line is course of 18 gauge Tuohy needle and subsequent 20 gauge polyethylene catheter [93].…”

“…Based upon the result of this block, a surgical (open technique) left cardiac sympathetic denervation was performed. It was important for us in this case to establish a continuous left sympathetic blockade infusion for 6 days in order minimize the likelihood that we were simply observing a period of spontaneous ectopic quiescence [93]. No definitive studies have addressed specifically the optimal time for blockade before definitive treatment is employed.…”