Ali Rehan, Ciccone Jeffrey, Tseng Victor
Icahn School of Medicine at Mount Sinai Department of Anesthesiology/Division of Pain Medicine, New York, NY.
J Clin Anesth. 2017 Feb;36:47-50. doi: 10.1016/j.jclinane.2016.07.037. Epub 2016 Nov 18.
A 75-year-old man presented with dizziness and fatigue secondary to ventricular and supraventricular arrhythmias. He underwent an elective ablation but continued to suffer from ventricular tachycardia with cardiovascular instability despite antiarrhythmic therapy with multiple agents. The patient continued to develop episodes of ventricular tachycardia and an episode of ventricular fibrillation. Electrical storm encompasses a situation of cardiac instability which may present as several episodes of ventricular tachycardia or ventricular fibrillation in a short period. We performed an ultrasound-guided left stellate ganglion block at the bedside which resulted in abolition of electrical storm. The patient demonstrated sinus rhythm with episodes of sinus tachycardia. Left stellate ganglion block has proven to be a successful mode of treatment for those patients with ventricular tachyarrhythmia resistant to medical management or those who fail atrioventricular node ablation. Ultrasound-guided left stellate ganglion block is a valuable and effective means to providing sympathectomy in the management of electrical storm or ventricular tachyarrhythmias.
一名75岁男性因室性和室上性心律失常出现头晕和疲劳。他接受了择期消融术,但尽管使用多种药物进行抗心律失常治疗,仍持续出现伴有心血管不稳定的室性心动过速。该患者继续出现室性心动过速发作及一次心室颤动发作。电风暴是一种心脏不稳定状态,可能表现为在短时间内多次发作室性心动过速或心室颤动。我们在床边进行了超声引导下左星状神经节阻滞,结果电风暴消失。患者表现为窦性心律伴窦性心动过速发作。对于那些对药物治疗耐药的室性快速性心律失常患者或房室结消融失败的患者,左星状神经节阻滞已被证明是一种成功的治疗方式。超声引导下左星状神经节阻滞是在电风暴或室性快速性心律失常管理中提供交感神经切除术的一种有价值且有效的手段。