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Bilateral thoracic sympathetic block for refractory polymorphic tachycardia.

Frederick Allen¹, Brian Weaver, Adam Burkey

¹Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. fredallenmd@gmail.com

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie

|October 6, 2011

Summary

A novel lytic thoracic sympathetic block offers a less invasive treatment for refractory ventricular tachycardia. This procedure showed clinical improvement with minimal morbidity in a patient with cardiomyopathy.

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Area of Science:

Cardiology
Pain Medicine
Interventional Cardiology

Background:

Sympathetic nervous system hyperactivity is linked to ventricular arrhythmias and sudden cardiac death.
Cardiac sympathectomy can treat high-risk patients but is invasive.
Refractory ventricular tachycardia poses a significant clinical challenge.

Observation:

A 74-year-old male with ischemic cardiomyopathy experienced refractory ventricular tachycardia despite maximal medical and interventional therapies.
The patient developed sustained ventricular tachycardia requiring vasopressors.
An open thoracoscopic sympathectomy was deemed too risky; a lytic thoracic sympathetic block was performed instead.

Findings:

The lytic thoracic sympathetic block resulted in a period of clinical improvement for the patient.
The procedure was associated with no apparent morbidity.
This technique represents a less invasive alternative to traditional cardiac sympathectomy.

Implications:

Lytic thoracic sympathetic blockade is a potentially viable, minimally invasive treatment for sympathetically mediated ventricular tachycardia.
Further studies are needed to validate this technique for patients at high risk of ventricular ectopy.
This case suggests feasibility and low morbidity for refractory ventricular arrhythmias.