title: Left stellate ganglion block for continuous ventricular arrhythmias during percutaneous left ventricular assist device support.
abstract: A 58-year-old man presented with chest pain and tightness and was diagnosed with a Q-wave anterior myocardial infarction. He then developed pulseless ventricular arrhythmias, which were treated with repeated direct-current shocks and intravenous amiodarone. He underwent emergency cardiac catheterization: stents were deployed in the left anterior descending coronary artery and right coronary artery, and an intra-aortic balloon pump was inserted. Severe refractory cardiogenic shock and incessant ventricular arrhythmias compelled us to place a TandemHeart percutaneous left ventricular assist device 4 hours later. The patient's hemodynamic status stabilized, but the arrhythmias persisted for 36 hours. Multiple doses of intravenous amiodarone and lidocaine and multiple external direct-current shocks were all tried, but these measures failed to terminate the life-threatening ventricular arrhythmias. We performed a pharmacologic block of the left stellate ganglion, and this resulted in a return to sinus rhythm after 1 direct-current shock. To our knowledge, this is the 1st patient with refractory ventricular arrhythmias to have been treated with TandemHeart support and left stellate ganglion block.
authors.affiliation: Department of Cardiology, The Texas Heart Institute at St. Luke's Episcopal Hospital, TX 77030, USA. pranavloyalka@yahoo.com
authors.forename: Pranav
authors.initials: P
authors.lastname: Loyalka
authors.forename: Ramesh
authors.initials: R
authors.lastname: Hariharan
authors.forename: Gunjan
authors.initials: G
authors.lastname: Gholkar
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: Ravi
authors.initials: R
authors.lastname: Tamerisa
authors.forename: Sriram
authors.initials: S
authors.lastname: Nathan
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D056988:Anterior Wall Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001340:Autonomic Nerve Block; D003131:Combined Modality Therapy; D004351:Drug Resistance; D004562:Electrocardiography; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013233:Stellate Ganglion / Q000503:physiopathology*; D015607:Stents; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left
chemical_list: D000889:Anti-Arrhythmia Agents