Key result
Ultrasound-guided left stellate ganglion block with 5 mL of 0.25% ropivacaine rapidly reduced PVC frequency to 1-2/min, shortened QTc from 520-530 ms to 490-500 ms, and eliminated recurrent TdP.
Why the study?
Although ultrasound-guided left stellate ganglion block can rapidly achieve cardiac sympathetic blockade in congenital long QT syndrome, its application in intraoperative rescue has been scarcely documented.
Does ultrasound-guided left stellate ganglion block suppress drug-refractory ventricular arrhythmias in a patient with clinically suspected congenital long QT syndrome following resuscitation from intraoperative torsades de pointes?
Case Report (n=1)
No
Does ultrasound-guided left stellate ganglion block suppress drug-refractory ventricular arrhythmias in a patient with clinically suspected congenital long QT syndrome following resuscitation from intraoperative torsades de pointes?
Ultrasound-guided left stellate ganglion block may serve as a rapid, effective adjunctive rescue intervention for intraoperative, drug-refractory ventricular arrhythmias and torsades de pointes in patients with suspected congenital long QT syndrome.
Answers are grounded in this paper and cite their sources.
May serve as rescue adjunct for refractory intraoperative TdP; leaves open need for prospective trials in long QT syndrome.
Background Congenital long QT syndrome (cLQTS) predisposes patients to torsades de pointes (TdP) under sympathetic stress. Although ultrasound-guided left stellate ganglion block (LSGB) can rapidly achieve cardiac sympathetic blockade, its application in intraoperative rescue has been scarcely documented. Case A 53-year-old woman with clinically suspected cLQTS (QTc 499 ms) developed pulseless TdP during fracture manipulation under general anesthesia. Following restoration of spontaneous circulation, frequent ventricular ectopy and short runs of TdP persisted despite treatment with magnesium sulfate, lidocaine, and esmolol. Following concomitant multimodal antiarrhythmic therapy, LSGB was performed with 5 mL of 0.25% ropivacaine, and a marked reduction of arrhythmias was observed shortly afterwards. No recurrent ventricular arrhythmias were observed during subsequent treatment and follow-up. Conclusions LSGB may be considered as an adjunct to pharmacological therapy when ventricular arrhythmia responds suboptimally and is presumed to be exacerbated by sympathetic stimulation in patients with QT prolongation.
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Cui et al. (2026) conducted a case report in Clinically suspected congenital long QT syndrome (cLQTS) with intraoperative pulseless torsades de pointes and refractory ventricular arrhythmias (n=1). Ultrasound-guided left stellate ganglion block (LSGB) with ropivacaine was evaluated on Suppression of refractory premature ventricular contractions (PVCs), torsades de pointes (TdP), and QTc interval stabilization. Ultrasound-guided left stellate ganglion block with 5 mL of 0.25% ropivacaine rapidly reduced PVC frequency to 1-2/min, shortened QTc from 520-530 ms to 490-500 ms, and eliminated recurrent TdP.
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