Percutaneous inferior cervical sympathetic ganglion blockade for the treatment of ventricular tachycardia storm: case report and review of the literature

Running Title: Sympathetic Block for Ventricular Tachycardia Storm.

Introduction: We present the case of a patient with ventricular tachycardia storm refractory to medical therapy and multiple catheter ablations, successfully managed by percutaneous left inferior cervical sympathetic ganglion block.

Summary: A 70-year-old man with a history of ischemic cardiomyopathy and previous placement of implantable defibrillator developed intractable ventricular tachycardia recalcitrant to intravenous amiodarone, lidocaine, and multiple catheter ablations with radiofrequency energy and direct current. The patient received numerous defibrillator shocks that did not result in sustained restoration of sinus rhythm. A percutaneous inferior cervical sympathetic ganglion block was performed under fluoroscopic guidance, with the administration of bupivacaine by infiltration of the tissue between the left internal carotid artery and the cervical vertebral bodies.

Results: Two and a half hours after the procedure, ventricular tachycardia converted to sinus rhythm. One month after discharge from the hospital, the patient remained free from sustained ventricular tachycardia and did not report discharges from his implantable defibrillator.

Conclusion: Percutaneous cervical sympathetic ganglion blockade appears to be an effective intervention in the treatment of ventricular tachycardia storm. Additional data are required before incorporating this technique into the management algorithm of incessant ventricular tachycardia.