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Emergent Phenol Injection of Bilateral Stellate Ganglion for Management of Refractory Malignant Ventricular Arrhythmias

Unusual or unexpected effect of treatment

Whitney R. Luke, Emile G. Daoud, Omar S. Latif

Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, OH, USA

Am J Case Rep 2020; 21:e921465

DOI: 10.12659/AJCR.921465

Available online: 2020-02-07

Published: 2020-03-19

BACKGROUND: Management of incessant electrical storm is poorly defined. These 2 case studies demonstrate a simplified percutaneous approach to achieve stellate ganglion ablation (SGA) and to promptly control malignant ventricular arrhythmias.
CASE REPORT: This report describes 2 patients with deteriorating hemodynamics, progressive ventricular arrhythmias, and worsening heart failure, managed with emergent percutaneous fluoroscopically-guided bilateral SGA to achieve bilateral cardiac sympathetic denervation. While supine and intubated, the left and then right stellate ganglion were identified guided by anatomic landmarks. Using a 22-guage, 3.5-inch spinal needle, contrast dye was injected with appropriate outline of the stellate ganglion at the uncinate process of the C6 vertebra. Bupivacaine 0.5% was injected, followed by phenol 6%. Successful SGA was confirmed by intentional Horner’s syndrome with bilateral eye lag. The procedures were completed in about 30 min without complications and there was a dramatic reduction in ventricular arrhythmias.
CONCLUSIONS: Emergent percutaneous bilateral SGA can be accomplished with a brief procedure resulting in management of electrical storm.

Keywords: Stellate Ganglion, Sympathectomy, Chemical, Tachycardia, Ventricular