Placement of a Continuous Stellate Ganglion Block for Treatment of Refractory Ventricular Fibrillation in the Setting of Known Prinzmetal Angina During Pregnancy: A Case Report

Abstract

A patient with a history of Prinzmetal angina, refractory ventricular fibrillation, cardiac arrest with an implantable cardioverter-defibrillator, and obesity presented to the emergency department at 17 weeks gestational age with a chief complaint of angina and multiple episodes of defibrillation. A T3/4 thoracic epidural was placed to assess the effectiveness of a partial chemical sympathectomy in alleviating symptoms of angina as well as decreasing the amount of defibrillation episodes. Once this proved to be beneficial in accomplishing both of these goals, a more specific approach was designed. A continuous stellate ganglion block was then placed controlling both her angina and preventing further episodes of defibrillation long enough for her pregnancy to progress beyond 24 weeks gestational age.

Continuous stellate ganglion block for ventricular arrhythmias: case series, systematic review, and differences from thoracic epidural anaesthesia

“…Most (12, 71%) are case reports, and expect for two, 25 , 26 the rest are single-centre studies. Nine (56%) studies report on C-PSGB, two 20 , 27 on both C-PSGB and TEA (in one case series TEA was used as a bailout strategy for non-responders to C-PSGB, 27 and in one case report TEA was performed before C-PSGB 20 ), and six on TEA alone. 23–26 , 28 , 29 Overall, 35 patients received 36 C-PSGBs, while 22 patients received TEA.…”

“…While most published experiences reported the usage of ropivacaine, 11 , 16 , 19 , 20 , 22 we used either lidocaine or ropivacaine. For ropivacaine, we observed a dose–response relationship that supports starting infusion rates of at least 12 mg/h.…”

Characterization of novel lncRNAs in upper thoracic spinal cords of rats with myocardial ischemia‑reperfusion injuries

“…Moreover, autonomic dysregulation following MIRI is an important pathogenic event (43)(44)(45)(46)(47). Interactions between the heart and spinal autonomic nervous system serve a role in both the development and maintenance of MIRI, and are also crucial in myocardial ischemia-induced angina pectoris (48)(49)(50)(51)(52). Based on the importance of the spinal autonomic nervous system in the pathophysiology of MIRI, there has been a notable effort in this field to study changes in the genomics, transcriptomics, proteomics and metabolomics in the spinal cord after MIRI, which could facilitate both existing interventions and novel therapies directed at cardiac-autonomic targets (53).…”

Management of Coronary Artery Spasm

“…Importantly, suppression of a heightened sympathetic drive to the heart has also been achieved with non-pharmacological 'neural therapies', including left stellate ganglion blockade, obtained with the use of anaesthetic drugs or radiofrequency ablation; endoscopic thoracic left sympathetic denervation; or even cardiac sympathetic denervation (plexectomy), usually applied in patients who have also undergone coronary artery bypass grafting (CABG). [86][87][88][89][90][91]…”