title: Comparative efficacy of stellate ganglion block with bupivacaine vs pulsed radiofrequency in a patient with refractory ventricular arrhythmias.
abstract: There is increasing interest in interventional therapies targeting the cardiac sympathetic nervous system to suppress ventricular arrhythmias. In this case report, we describe an 80-year-old patient with ischemic cardiomyopathy and multiple implantable cardioverter-defibrillator shocks due to refractory ventricular tachycardia and ventricular fibrillation who was unable to continue biweekly stellate ganglion block procedures using bupivacaine 0.25% for suppression of his arrhythmias. He had previously failed antiarrhythmic drug therapy with amiodarone, catheter ablation, and attempted surgical autonomic denervation. He underwent pulsed radiofrequency treatment (3 lesions, 2 minutes each, temperature 42°C, 2-Hz frequency, 20-millisecond pulse width) of the left stellate ganglion resulting in persistent arrhythmia suppression for more than 12 months duration. This represents the first report of a pulsed radiofrequency stellate ganglion lesion providing long-term suppression of ventricular arrhythmias. Further study of this technique in patients with refractory ventricular tachycardia or ventricular fibrillation is warranted.
authors.affiliation: University of California San Diego, San Diego, CA; Veterans Affairs San Diego Healthcare System, San Diego, CA.
authors.forename: Justin
authors.initials: J
authors.lastname: Hayase
authors.affiliation: University of California Los Angeles, Los Angeles, CA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Vampola
authors.affiliation: University of California San Diego, San Diego, CA; Veterans Affairs San Diego Healthcare System, San Diego, CA.
authors.forename: Farshad
authors.initials: F
authors.lastname: Ahadian
authors.affiliation: Stanford University, Palo Alto, CA.
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Narayan
authors.affiliation: University of California San Diego, San Diego, CA; Veterans Affairs San Diego Healthcare System, San Diego, CA. Electronic address: dkrummen@ucsd.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Krummen
mesh_terms: D000369:Aged, 80 and over; D000779:Anesthetics, Local; D001340:Autonomic Nerve Block / Q000379:methods*; D002045:Bupivacaine; D017115:Catheter Ablation / Q000379:methods*; D006801:Humans; D008297:Male; D013233:Stellate Ganglion / Q000187:drug effects*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine