Journal of Acute Care

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VOLUME 3 , ISSUE 1 ( January-April, 2024 ) > List of Articles

CASE REPORT

Neuraxial Modulation in Electrical Storm: A Case Report

Poonam P Rai, Justin A Gopaldas, Suhas Aithal, Nikhil Narayanaswamy, Deepak Padmanabhan, Balaraju Doddaiah

Keywords : Antiarrhythmic agents, Case report, Electrical storm, Mexiletine, Myocardial ischemia, Neuraxial modulation, Stellate ganglion block, Surgical sympathectomy, Sympatholytic therapy, Ventricular arrhythmia

Citation Information : Rai PP, Gopaldas JA, Aithal S, Narayanaswamy N, Padmanabhan D, Doddaiah B. Neuraxial Modulation in Electrical Storm: A Case Report. 2024; 3 (1):28-31.

DOI: 10.5005/jp-journals-10089-0100

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aims and background: Management of unstable and refractory electrical storm (ES) requires a multidisciplinary approach in an intensive care unit (ICU). A dysregulated autonomic system is understood to be the cause of perpetual arrhythmogenesis. Case description: We present a case of refractory ES precipitated by myocardial ischemia (MI), which was promptly managed with primary percutaneous coronary intervention (PPCI). Despite successful reperfusion with PPCI, the patient continued to have arrhythmias for a prolonged period than expected. Due to refractory arrhythmia, escalation of antiarrhythmic drugs (AADs) along with sequential sympatholytic therapy was undertaken. Conclusion: The use of neuraxial modulation [initially stellate ganglion block (SGB) followed by surgical sympathectomy] may lead to the control of arrhythmia and hemodynamic stability in this difficult subset of patients. Clinical significance: Unstable ES is due to inappropriate sympathetic system activation and there is mounting evidence in support of neuraxial modulation as the main modality rather than escalating traditional AADs.


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