Elective percutaneous stellate ganglion block for prediction of the clinical outcome of robotic bilateral cardiac sympathetic denervation in a patient with Andersen–Tawil syndrome

Andersen–Tawil syndrome (ATS) is an ultra-rare channelopathy. We report the case of a 35-year-old woman with genetically confirmed ATS. She experienced sudden cardiac arrest. Her medical history was notable for multiple appropriate implantable cardioverter–defibrillator interventions due to ventricular fibrillation and ventricular tachycardia. Numerous premature ventricular contractions were revealed in 24-h Holter ECG monitoring. The arrhythmic episodes were consistently triggered by physical activity, despite multiple antiarrhythmic therapies and two endocardial ablations. A two-step strategy was planned, with the decision to proceed to bilateral cardiac sympathetic denervation (BCSD) based on the outcome of an initial percutaneous stellate ganglion block (PSGB). An elective left-sided percutaneous stellate ganglion block resulted in complete suppression of premature ventricular contractions and improved exercise tolerance. Guided by this response, the patient underwent robotic BCSD, leading to a spectacular reduction of premature beats, disappearance of symptomatic arrhythmias, and normalisation of exercise capacity. No recurrences were observed during the 5-month follow-up. This case is the first to describe elective PSGB as a predictive tool for the efficacy of BCSD in ATS. PSGB may facilitate patient selection for invasive autonomic modulation, offering a novel strategy for refractory inherited channelopathies.