Ultrasound-Guided Regional Anesthesia for Repeat Ventricular Arrhythmia Catheter Ablation: A Case Report

Catheter ablation procedures for ventricular arrhythmias are often performed under general anesthesia or total intravenous anesthesia to prevent patient movement and discomfort. However, anesthetic agents such as propofol, opioids, and dexmedetomidine can suppress ventricular arrhythmias, preventing successful mapping and ablation during the procedure. Here, we present the case of a 25-year-old female with premature ventricular contractions (PVC) and ventricular tachycardia (VT) who underwent a successful catheter ablation procedure using regional anesthesia after two previously unsuccessful ablation attempts. The first attempt used total intravenous anesthesia to perform the ablation. However, patient movement complicated the mapping, and ventricular arrhythmias returned in a few weeks. The second procedure used decreased total intravenous sedation to reduce arrhythmia suppression; however, no arrhythmias were able to be induced, and the patient continued to have episodes of ventricular tachycardia. To prevent potential arrhythmia suppression from the prior anesthetic agents used, a different anesthetic approach was used for the third attempt: ultrasound-guided peripheral nerve blocks of the right ilioinguinal, iliohypogastric, obturator, and lateral femoral cutaneous nerves. To the authors’ current knowledge, there have been no reports in the literature describing regional anesthesia as the primary anesthetic technique specifically to avoid arrhythmia suppression during ventricular arrhythmia catheter ablation procedures. This technique enabled successful arrhythmia inducibility, which in turn allowed for accurate mapping and ablation.