Toma Galkuvienė, Gabrielė Ramanauskaitė, Augustė Klišmontaitė, Diana Rinkūnienė
Abstract
Electrical storm (ES) is a critical cardiac emergency characterized by recurrent, life-threatening ventricular arrhythmias occurring within a short period, most commonly in patients with structural heart disease, particularly those who have an implantable cardioverter-defibrillator (ICD) for secondary prevention, as the device records recurrent ventricular arrhythmias that characterize electrical storm. Despite advances in antiarrhythmic therapy and catheter ablation, some patients remain refractory to conventional management, resulting in significant morbidity and mortality. Recent evidence highlights the potential role of autonomic modulation, particularly stellate ganglion block (SGB), as an adjunctive or rescue therapy in these cases. This article presents the clinical case of a 75-year-old patient with ischemic cardiomyopathy and recurrent episodes of sustained ventricular tachycardia refractory to standard pharmacologic therapy (amiodarone, lidocaine, beta-blockers) and ICD interventions. This case emphasizes the importance of recognizing SGB as a viable, minimally invasive, and potentially life-saving intervention for patients with ES who do not respond to conventional treatment. Furthermore, as its effects are transient, SGB may serve as a diagnostic and bridging step toward definitive sympathetic modulation through surgical cardiac sympathetic denervation in recurrent or refractory cases.
Keyword(s): Ventricular tachycardia, Electrical storm, Stellate ganglion block, Cardiac sympathetic denervation, Autonomic modulation, Refractory arrhythmia.
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