Blocking the Sympathetic Storm: Adjunctive Left Stellate Ganglion Block for Refractory Ventricular Tachycardia After Inferolateral Myocardial Infarction

Electrical storm following myocardial infarction (MI) can be difficult to control when antiarrhythmic drugs and cardioversion fail.We describe a 53-year-old man with hypertension and previously undiagnosed diabetes who presented with an inferolateral ST-segment elevation MI caused by total occlusion of the proximal left circumflex artery, which was treated with primary percutaneous coronary intervention and drug-eluting stent placement.He then developed marked leukocytosis with a systemic inflammatory response and acute kidney injury (peak creatinine, 4.03 mg/dL), which resolved with empirical antibiotic therapy and supportive renal care.On day 6, he experienced recurrent syncope associated with sustained monomorphic ventricular tachycardia (VT) that persisted despite intravenous amiodarone and lidocaine, electrolyte correction, and repeated cardioversion, necessitating sedation and mechanical ventilation.Repeat coronary angiography demonstrated a patent stent.VT ceased following an ultrasound-guided left stellate ganglion block (SGB) using 1% lidocaine and dexamethasone, which resulted in Horner syndrome.Antiarrhythmic therapy was continued, and the patient was extubated within 24 hours.Speckle-tracking echocardiography demonstrated severely reduced lateral and anterior strain (global longitudinal strain, -12.0%).A patent stent in the culprit vessel and sustained monomorphic arrhythmia made a scar-related substrate the leading consideration.The close temporal association between the block and cessation of VT suggests that sympathetic blockade may have contributed to arrhythmia control, although the continuation of antiarrhythmic therapy precludes firm causal conclusions.Left SGB may serve as a rapid bridge to definitive treatment in patients with refractory electrical storm.