Key result
Bilateral sympathetic ganglionectomy stabilizes a patient with refractory electrical storm after STEMI, eliminating monomorphic VT.
Why the study?
Electrical storm is life-threatening, and in refractory cases, cardiac sympathetic denervation can help reduce arrhythmia burden and implantable cardioverter-defibrillator shocks.
Does bilateral sympathetic ganglionectomy improve refractory electrical storm in a patient with ischemic cardiomyopathy?
Case Report (n=1)
No
Does bilateral sympathetic ganglionectomy improve refractory electrical storm in a patient with ischemic cardiomyopathy?
Bilateral sympathetic ganglionectomy offers comprehensive autonomic modulation and may provide definitive control of refractory arrhythmias in patients with ischemic cardiomyopathy.
Answers are grounded in this paper and cite their sources.
Should not yet change practice in refractory electrical storm; leaves open the role of bilateral sympathetic ganglionectomy in ischemic cardiomyopathy.
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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Watson et al. (2025) 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.
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