Combined Impella support and left stellate ganglion block in STEMI-related arrhythmic storm: a case report

Arrhythmic complications during the acute phase of ST-elevation myocardial infarction (STEMI) occur in approximately 6–8% of cases and can be life-threatening. While prompt myocardial revascularization often addresses the underlying ischemic mechanism, a deteriorating hemodynamic status may significantly limit its success. We report the case of a patient presenting with STEMI complicated by electrical storm and cardiogenic shock. Mechanical circulatory support with the Impella device, combined with a percutaneous left stellate ganglion block (PSGB), was employed to achieve hemodynamic stabilization and rhythm control, thereby enabling successful coronary revascularization. This case highlights the synergistic role of mechanical support and autonomic modulation in managing complex STEMI presentations. The combined use of Impella and PSGB may represent a valuable therapeutic approach in selected patients with refractory arrhythmias and hemodynamic instability. • Early mechanical circulatory support may help stabilize patients with STEMI complicated by cardiogenic shock. • Percutaneous stellate ganglion block may contribute to suppression of electrical storm via autonomic modulation in patients with STEMI. • Combined Impella and PSGB support may facilitate successful revascularization and prompt clinical improvement in otherwise unstable patients