title: Autonomic Modulation for the Treatment of Ventricular Arrhythmias: Therapeutic Use of Percutaneous Stellate Ganglion Blocks.
abstract: Ventricular tachycardia (VT), ventricular fibrillation (VF), and electrical storm are commonly encountered emergency conditions in cardiac and surgical intensive care units. In most cases, recurrent ventricular arrhythmias or electrical storm are associated with a heightened sympathetic tone. These arrhythmias can be difficult to treat and may be refractory to beta-blockade, antiarrhythmic therapy, sedation, and mechanical hemodynamic support. While monomorphic ventricular tachycardia and PVC-triggered polymorphic ventricular tachycardia may sometimes be amenable to successful ablation, some patients may be too critically ill to make such an approach feasible. We present 2 cases of minimally invasive stellate ganglion blocks for the treatment of electrical storm in patients with advanced heart failure on mechanical life support. These cases are part of a collaborative initiative at our institution to use percutaneous stellate ganglion block as an adjunctive intervention to achieve control of life-threatening ventricular arrhythmias.
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Marat
authors.initials: M
authors.lastname: Fudim
authors.affiliation: Duke Anesthesiology, Duke University, Durham, North Carolina, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Boortz-Marx
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Albert Y
authors.initials: AY
authors.lastname: Sun
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.|Duke Clinical Research Institute, Durham, North Carolina, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D001340:Autonomic Nerve Block / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage*; D004562:Electrocardiography; D006321:Heart / Q000294:innervation*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D013233:Stellate Ganglion / Q000187:drug effects* / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine
keywords: autonomic modulation; electrical storm; stellate ganglion block; sympathetic tone