Anaesthetic management of arrhythmic storm by sympathetic block

Abstract

The arrhythmic storm is defined by the presence of three or more episodes of ventricular tachycardia, ventricular fibrillation and / or discharges of an implantable cardioverter defibrillator (ICD) in a 24-hour period. In its management, the identification and correction of triggering factors is essential, such as myocardial ischemia, hydroelectrolyte alterations, decompensation of heart failure, as well as the adequate control of sympathetic tone.

We present the case of a 43-year-old man with apical hypertrophic cardiomyopathy, carrier of ICD in primary prevention who arrives due to an arrhythmic storm with difficult pharmacological control and ineffective ablation, with important clinical repercussions.

Before possible component of adrenergic discharge, it was decided to implant a high epidural catheter reaching sympathetic blockade with lidocaine perfusion and reduction of arrhythmic episodes. Subsequently, bilateral thoracic sympathectomy with favorable evolution was performed.