Ultrasound-guided stellate ganglion block for refractory sympathetically mediated arrhythmia following acute...

Sympathetic arrhythmia represents a life-threatening complication following acute myocardial infarction (AMI), which is characterized by recurrent episodes of electrical dysrhythmias that are often refractory to antiarrhythmic medications and thereby necessitate repeated electrical cardioversion or defibrillation. This case series aims to evaluate the efficacy and safety of ultrasound-guided stellate ganglion block (SGB) as a rescue therapy for refractory ventricular arrhythmias and one case of rapid atrial flutter following AMI.

We retrospectively analyzed five AMI patients with refractory sympathetically arrhythmia who failed standard medical management. All patients were of Han ethnicity from China, consisting of three males and two females, with ages ranging from 29 to 87 years. All patients underwent bedside ultrasound-guided SGB (unilateral or bilateral) with 1% lidocaine hydrochloride. The primary outcomes were immediate termination of sympathetically arrhythmia and 24-hour arrhythmia-free survival.

SGB successfully aborted electrical storm in all 5 patients (100%). The median number of defibrillations per patient decreased significantly from 4 [interquartile range (IQR): 2.5-21] before SGB to 0 (IQR: 0-1) after SGB. The development of ipsilateral Horner syndrome in all cases confirmed successful sympathetic blockade, and no procedure-related complications were observed.

SGB is a safe and effective bedside intervention for terminating and stabilizing refractory sympathetically arrhythmia in post-AMI patients. It can serve as an important adjunctive therapy to reduce the need for repeated electrical defibrillation. Further prospective randomized controlled studies are warranted to validate its clinical application in acute arrhythmia management.