Autonomic Modulation for Treatment of Repolarization Alternans and Refractory Ventricular Electrical Storm

Figure 1. Electrocardiogram on Day of Admission Sinus rhythm rate 57 beats/min with prolonged QTc of 640 ms.

Figure 2. Electrocardiogram Following Nadolol and Mexiletine Initiation Normal sinus rhythm rate 60 beats/min. QTc interval 539 ms.

Figure 3. Telemetry Rhythm Strip Demonstrating Prolongation of the QTc Interval With R-on-T Phenomenon Initiating Polymorphic Ventricular Tachycardia

Figure 4. Electrocardiogram Peri-Arrest Reveals Sinus Bradycardia at a Rate of 53 beats/min QTc interval 827 ms with macroscopic T-wave alternans.

Figure 5. Electrocardiogram Following Stellate Ganglion Blockade Shows Normal Sinus Rhythm at a Rate of 79 beats/min QTc interval 597 ms and T-wave alternans has resolved, although increased heart rate must be considered compared to prior electrocardiogram.

Figure 6. Relevant Anatomic Landmarks During Stellate Ganglion Blockade