Intraoperative rescue left stellate ganglion block for refractory ventricular arrhythmias following resuscitation from torsades de pointes: a case report

Background Congenital long QT syndrome (cLQTS) predisposes patients to torsades de pointes (TdP) under sympathetic stress. Although ultrasound-guided left stellate ganglion block (LSGB) can rapidly achieve cardiac sympathetic blockade, its application in intraoperative rescue has been scarcely documented. Case A 53-year-old woman with clinically suspected cLQTS (QTc 499 ms) developed pulseless TdP during fracture manipulation under general anesthesia. Following restoration of spontaneous circulation, frequent ventricular ectopy and short runs of TdP persisted despite treatment with magnesium sulfate, lidocaine, and esmolol. Following concomitant multimodal antiarrhythmic therapy, LSGB was performed with 5 mL of 0.25% ropivacaine, and a marked reduction of arrhythmias was observed shortly afterwards. No recurrent ventricular arrhythmias were observed during subsequent treatment and follow-up. Conclusions LSGB may be considered as an adjunct to pharmacological therapy when ventricular arrhythmia responds suboptimally and is presumed to be exacerbated by sympathetic stimulation in patients with QT prolongation.