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Thoracic Aneurysm Growth and Surveillance — EECC MCQ

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HardAortic DiseaseThoracic Aneurysm Growth and SurveillanceEECC

A patient with structural heart disease has refractory electrical storm despite deep sedation, beta-blockade, amiodarone, correction of triggers and repeated ICD reprogramming. Transfer for ablation will take six hours. Which temporary autonomic intervention can suppress recurrent ventricular arrhythmia?

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Correct answer: A — Perform ultrasound-guided left stellate-ganglion block as a bridge to ablation

Temporary left stellate-ganglion blockade targets cardiac sympathetic efferents and can reduce ventricular-arrhythmia burden while definitive ablation or surgical denervation is arranged. Right phrenic-nerve and recurrent-laryngeal-nerve blockade do not interrupt the relevant cardiac sympathetic outflow. Repeated carotid-sinus massage is a vagal manoeuvre for selected supraventricular tachycardias, not an established treatment for ventricular electrical storm, and may cause hypotension or bradycardia. Renal sympathetic denervation is not an immediate bedside bridge for refractory storm.

Reference: 2022 ESC Guidelines for ventricular arrhythmias and sudden cardiac death. https://academic.oup.com/eurheartj/article/43/40/3997/6675633