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Stellate ganglion blockade combined with nifekalant for patients with electrical storm: a case report

Takuya Kiyohara1, Kenta Sakaguchi1, Daichi Maeda1

  • 1Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686Japan.

European Heart Journal. Case Reports
|December 30, 2022
PubMed

Insights

Combination therapy of stellate ganglion blockade and nifekalant effectively controlled refractory electrical storm in a patient with acute myocardial infarction. This approach suppressed ventricular arrhythmia, improving hemodynamic status and preventing recurrence.

Area of Science:

  • Cardiology
  • Clinical Electrophysiology
  • Pharmacology

Background:

  • Electrical storm is a life-threatening condition characterized by recurrent ventricular arrhythmias.
  • Stellate ganglion blockade and nifekalant are known treatments for electrical storm, but their combined efficacy is not well-established.
  • Refractory electrical storm poses significant management challenges, often requiring multimodal therapeutic strategies.

Observation:

  • A 71-year-old male with acute myocardial infarction and heart failure developed electrical storm refractory to standard treatments, including percutaneous coronary intervention and antiarrhythmic drugs.
  • Stellate ganglion blockade initially reduced ventricular arrhythmia, but discontinuation led to a substantial increase.
  • The patient's electrical storm resolved completely upon initiation of combination therapy with stellate ganglion blockade and nifekalant.

Findings:

  • Combined stellate ganglion blockade and nifekalant therapy demonstrated complete suppression of ventricular arrhythmia in a patient with refractory electrical storm.
  • This combination therapy led to improved hemodynamic status and prevented further arrhythmia episodes during hospitalization and follow-up.
  • Blocking multiple cardiac conduction pathways appears crucial for managing severe, treatment-resistant electrical storm.

Implications:

  • This case suggests that combination therapy with stellate ganglion blockade and nifekalant may be a valuable strategy for managing refractory electrical storm.
  • Targeting multiple autonomic and electrical pathways could offer a synergistic effect in preventing life-threatening ventricular arrhythmias.
  • Further research is warranted to explore the safety and efficacy of this combined therapeutic approach in a broader patient population.
Abstract

Keywords:
Case reportCombination therapyElectrical stormNifekalantStellate ganglion blockadeVentricular arrhythmia

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