A case of post-STEMI electrical storm with multiple ICD shocks
refractory to antiarrhythmic medications, treated successfully with
bilateral sympathetic ganglionectomy.
Abstract
Electrical storm (ES) is a life-threatening condition that requires a
stepwise management approach, including antiarrhythmics,
anxiolytics/sedatives, antiadrenergic, and hemodynamic support. In 88%
of refractory cases, cardiac sympathetic denervation has proven
effective in reducing ventricular tachycardia (VT) burden and ICD
shocks. We present a patient with late-presenting ST-elevation
myocardial infarction (STEMI), new reduced left ventricular ejection
fraction (LVEF), post coronary artery bypass graft (CABG), who
experienced recurrent monomorphic VT despite amiodarone, lidocaine, and
left stellate ganglion block, who was successfully treated with
bilateral video-assist thoracoscopy sympathetic ganglionectomy.