Cardiac arrhythmias in acute central nervous system disease. Successful management with stellate ganglion block.

Cardiac rhythm disturbances and ECG wave-form abnormalities have been described with CNS disease or injury in experimental animals and in man. Unilateral sympathetic stimulation has been shown to produce similar changes in ventricular repolarization and reduce the fibrillation threshold. A patient with a ruptured congenital aneurysm of the basilar artery developed an accelerating ventricular tachycardia associated with an episode of active intracranial bleeding. The rhythm disturbance proved refractory to all modalities of chemotherapy, including lidocaine, phenytoin, atropine, procainamide, digoxin, and propranolol. The ECG showed a repolarization abnormality similar to that described with left stellate ganglion stimulation. Left stellate ganglion block was carried out with 15 ml of 1% lidocaine. An effect on the tachyarrhythmia was noted in five minutes. By 15 minutes, the rhythm disturbance was abolished. The repolarization abnormalities improved over a period of hours. Successful management with left stellate ganglion block suggests that this form of therapy may have clinical application in arrhythmias associated with CNS disease.