To Tide over an Electrical Storm: a Novel Approach in the Management of a Child with LQTS

Aim: A novel method in the management of a child with LQTS with Torsades de pointes electrical storm.

Methods and Results:

• A 10 year old male child diagnosed to have seizure disorder since five years on three anti-epileptics (Clobazam, Leviteracetam, Carbamazepine) admitted in the Pediatric department, was referred to us for recurrent and resistant ventricular tachycardia- Torsades de pointes.
• The child had received about 40 DC shocks over last three hour and in spite of treatment with amiodarone, lidocaine, magnesium, B-blockers the VT was recurrent and unrelenting.
• Two elder siblings had sudden cardiac death history

• ECG showed Torsades de pointes
• 2D-Echo: No structural abnormalities.
• MRI brain and EEG- normal
• Serum electrolytes- Normal

-At this stage it was decided to do stellate ganglion block to tide over the unrelenting VT storm.

-Initially Left stellate ganglion block with 10 ml of 0.25% bupivacaine under ultrasound guidance was done and there was substantial decrease in the VT episodes.

-DC shock requirement decreased to 4-6/12 hours.

-Subsequently successful Right stellate ganglion block was done with 10 ml of 0.25% bupivacaine under ultrasound guidance.

-There was complete cessation of the VT episodes and patient became asymptomatic.

-On further evaluation the child was found to have LQTS and on screening the family members the parents as well as elder sister was also found to have LQTS.

-The child was advised ICD implantation and subsequently discharged with beta blocker drug and advised against physical exertion and so were the other family members as well.

Conclusions:

• Stellate ganglion block followed by surgical cardiac denervation is an effective treatment modality to reduce the incidents of malignant ventricular arrhythmias.
• The Stellate ganglion block may serve as a simple bedside tool to identify the patients who are likely to respond to the more definite but more invasive modality of Sympathectomy.