Congenital long QT

[pgg]

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Have a 40 yo patient scheduled for a 10 minute GYN procedure with this disorder, and a history of an arrest and resuscitation eventually resulting in placement of a pacer/AICD. She's beta blocked and takes K supplements. I wasn't planning on anything special beyond periop beta blockade and usual AICD and QT-prolonging drug precautions.

I was flipping through Co-Existing Disease and it mentions preop left stellate ganglion blocks. Is this archaic? I see a couple case-report caliber articles from 25+ years ago but have never seen this done or even heard of it until I opened the book. Not that a lot of congenital long QTs come through our OR. Does anybody really do this?

This patient's going to get her daily metoprolol, her K & Mg checked, and a couple hits of propofol for the procedure but I'm just curious if the blocks are common practice anywhere.

 

[Bertelman]

Never seen one.

 

[proman]

Last week we had a teen in the PICU with malignant VT resistant to treatment. EF went from 55 to less than 20% and the surgeons put him on ECMO. One of our pain guys offered and did an ultrasound guided stellate block. I don't know how effective it was but the blocks are still done. Stimulation of the left stellate ganglion prolongs QT and increases HR. It's thought that the left ganglion provides sympathetics to the cardiac plexus, so blocking it should theoretically help.

I had a patient in fellowship who had a a gain-of-function mutation of the myocardial ryanodine receptor which put her at risk of VT. She ended up doing fine with an ICD and thoracic sympathectomy.