October 1, 2025JACC Case Reports1 citationsOpen Access

Electrical Storm After STEMI Refractory to Medications Successfully Managed With Bilateral Sympathetic Ganglionectomy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Electrical storm after STEMI (n=1). Intervention: Bilateral video-assisted thoracoscopic sympathetic ganglionectomy. Primary outcome: Resolution of monomorphic ventricular tachycardia.

HWHangYu WatsonWest Virginia University Hospitals SBSeher BerzingiWest Virginia University EHEmily HendricksWest Virginia University

Key Result

Bilateral sympathetic ganglionectomy successfully stabilized a patient with refractory electrical storm after STEMI, resulting in the absence of further monomorphic ventricular tachycardia.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does bilateral sympathetic ganglionectomy improve refractory electrical storm in a patient with ischemic cardiomyopathy?

Population

A 40-year-old man with anteroseptal ST-segment elevation myocardial infarction, newly reduced LVEF (27% post-CABG), and refractory monomorphic ventricular tachycardia/electrical storm despite amiodarone, lidocaine, and left stellate ganglion block.

Intervention

Bilateral video-assisted thoracoscopic sympathetic ganglionectomy (resecting T2 to T4 sympathetic ganglia)

Outcome

Stabilization and absence of further monomorphic ventricular tachycardia

Bilateral sympathetic ganglionectomy offers comprehensive autonomic modulation and may provide definitive control of refractory arrhythmias in patients with ischemic cardiomyopathy.

Limitations

Single case report
Further prospective studies are needed to evaluate long-term outcomes and safety

Abstract

BACKGROUND: Electrical storm is a life-threatening condition often requiring antiarrhythmics, sedation, antiadrenergics, and hemodynamic support. In refractory cases, cardiac sympathetic denervation can help reduce arrythmia burden and implantable cardioverter-defibrillator shocks. CASE SUMMARY: A 40-year-old man presented with anteroseptal ST-segment elevation myocardial infarction and newly reduced left ventricular ejection fraction and underwent coronary artery bypass grafting during hospitalization. He subsequently developed refractory monomorphic ventricular tachycardia despite treatment with amiodarone, lidocaine, and a left stellate ganglion block. He was successfully treated with bilateral video-assisted thoracoscopic sympathetic ganglionectomy. DISCUSSION: In patients presenting with electrical storm, particularly those with ischemic cardiomyopathy, bilateral sympathetic ganglionectomy can be an effective treatment when ventricular arrhythmias are refractory to antiarrhythmic drugs and device optimization. TAKE-HOME MESSAGES: This case highlights that bilateral sympathetic ganglionectomy offers more comprehensive autonomic modulation than unilateral block and may provide definitive control of refractory arrhythmias. Temporary blocks may serve as diagnostic or therapeutic bridges to surgical intervention.

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Cite This Study

Watson et al. (Wed,) conducted a case report in Electrical storm after STEMI (n=1). Bilateral video-assisted thoracoscopic sympathetic ganglionectomy was evaluated on Resolution of monomorphic ventricular tachycardia. Bilateral sympathetic ganglionectomy successfully stabilized a patient with refractory electrical storm after STEMI, resulting in the absence of further monomorphic ventricular tachycardia.

synapsesocial.com/papers/6a1b7c7a0ac30a8853919a87 https://doi.org/https://doi.org/10.1016/j.jaccas.2025.105289

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