Electrical storm – Management

Electrical storm – Management Electrical storm: Recurrent unstable ventricular tachycardia (VT)/ventricular fibrillation (VF) requiring more than three direct current (DC) shocks per day. Beta blocker is the single most effective therapy for recurrent VT unless the person is in shock. A combination of intravenous amiodarone with oral propranolol has been found to be superior to intravenous amiodarone with oral metoprolol [1]. Stellate ganglion block / ablation is being increasingly used as a modality for treatment of drug refractory ventricular tachycardia. Temporary blockage of stellate ganglion can be obtained by injection lignocaine or bupivacaine for a longer effect [2]. Sometimes a cannula can be left in situ and a local anesthetic infusion started for a prolonged effect. Ablation of stellate ganglion chemically with alcohol or surgically are feasible. Video assisted thoracoscopy is a semi invasive option which is replacing open surgery for surgical ablation of stellate ganglion. There should be a low threshold for inserting IABP in those with electrical storm. Extracorporeal membrane oxygenation (ECMO) support is useful in pediatric cases as hemodynamic protection for aggressive antiarrhythmic medical treatment giving a survival more than 80% [3]. Moderate therapeutic  hypothermia has been shown to suppress electrical storms in a person with multi vessel coronary artery disease [4]. The converse is that patients with fever may have worsening of electrical s...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: ECG / Electrophysiology Ablation of stellate ganglion Stellate ganglion block Temporary blockage of stellate ganglion Source Type: blogs