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

Case series Patients: Male, 51-year-old • Male, 59-year-old Final Diagnosis: Ventricular tachycardia (VT) Symptoms: Cardiac arrest Medication: — Clinical Procedure: Ablation Specialty: Critical Care Medicine OBJECTIVE: Unusual or unexpected effect of treatment 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 REPORTS: 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.