Acute Crit Care.  2024 Nov;39(4):643-646. 10.4266/acc.2021.01683.

Successful neural modulation of bedside modified thoracic epidural anesthesia for ventricular tachycardia electrical storm

• Kang KW

• KMID: 2563554
• DOI: http://doi.org/10.4266/acc.2021.01683

Abstract

Ventricular tachycardia (VT)/ventricular fibrillation (VF) storm can be hemodynamically compromising and life-threatening. Management of medically refractory VT/VF storm is challenging in the intensive care unit. A 38-year-old male patient was diagnosed with non-ischemic heart failure and acute kidney injury with documented frequent premature ventricular contraction with QT prolongation after recurrent VT/VF. Even though the patient was intubated with sedatives and had taken more than two anti-arrhythmic drugs with external recurrent defibrillation at bedside, the electrical storm persisted for several hours. However, medically refractory VT/VF storm can be successfully and rapidly terminated with a modified thoracic epidural anesthesia at bedside. This case demonstrates that a bedside thoracic epidural anesthesia can be an effective non-pharmacological option to treat medically refractory VT/VF storm in the intensive care unit.

Keyword

intensive care unit; epidural anesthesia; ventricular tachycardia

Figure

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  Figure 1. (A) Rhythm strip shows a prolonged QT interval with a giant T-wave inversion (blue dotted line) and sudden initiation of ventricular tachycardia. Black arrow indicates first premature ventricular beat inducing ventricular tachycardia. (B) Rhythm strip shows sustained ventricular fibrillation degeneration in the setting of a long QT interval. (C) Rhythm strip shows that the incessant ventricular tachycardia/fibrillation was promptly terminated (asterisk) and restored to a sinus rhythm (blue dotted line) after the thoracic epidural anesthesia. ECG: electrocardiogram.

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  Figure 2. (A) Intubation tube (black arrow), right jugular vein sheath and defibrillation patch (asterisk) linear thoracic epidural catheter (white arrows). (B) Anatomical position of 18-G Tuohy needle with loss of resistance technique.

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  Figure 3. (A) A 12-lead electrocardiogram (ECG) shows a prolonged QT interval with a giant T-wave inversion before initiation of ventricular tachycardia at the period of the blue dotted line in Figure 1A. (B) A 12-lead ECG shows normalized QT prolongation with T-wave inversion after the thoracic epidural anesthesia at the period of the blue dotted line in Figure 1C. aVR: augmented vector right; aVL: augmented vector left; aVF: augmented vector foot.

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