Pharmacologic Blockade

A 29-year-old woman with LQTS suffered from five syncopes due to ventricular tachyarrhythmias despite treatment with 320 mg propranolol and 200 mg phenytoin daily. An operative left ganglion stellectomy was planned, but she refused surgery. Therefore we performed a transcutaneous pharmacologic blockade of the left stellate ganglion using 4 ml/mepivacaine 2 percent. After this procedure by continuing oral medication, no further cardiac rhythm disturbances appeared for four weeks. This encouraging observation led us to the decision to implant a drug-reservoir-pump system (SECOR, Cordis Corp, Fig 1) for continuous pharmacologic blockĀ­ade of the left stellate ganglion, which was accepted by the patient by her written consent to this procedure.

After local anesthesia, the drug-reservoir pump was implanted subcutaneously in the left upper abdominal quadrant. A special catheter was connected, subcutaneously directed to the left neck and after local incision placed directly into the region of the left stellate ganglion. The drug-reservoir contains 12 ml of a local anesthetic, and the pump-device delivers 0.1 ml per single dose, delivered mechanically by the patient. After release of 100 doses the reservoir can easily be refilled transcutaneously using a 25- gauge needle under sterile conditions. The reservoir was filled with mepivacaine 2 percent and the patient administered two doses of 0.1 ml mepivacaine daily in addition to oral medication. Since implantation of the reservoir-pump-system in May 1987 until December 1988, the patient revealed stable sinus rhythm, and ventricular tachyarrhythmic episodes or syncopes did not occur anymore. In addition there was no evidence of Horner’s syndrome or bradycardia.
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FIGURE 1. The pump-reservoir system

FIGURE 1. The pump-reservoir system is implanted subcutaneously into the right upper abdominal quadrant. A special catheter is connected and directed subcutaneously into the region of the left neck. After local incision the catheter tip is placed directly into the region of the left stellate ganglion (arrow).

Conclusion

This encouraging result suggests that pharmacologic blockade of the left stellate ganglion, using a permanent drug reservoir-pump-system complementary to oral mediĀ­cation (propranolol + phenytoin), may be effective in patients with LQTS, who suffer from syncopes despite adequate oral drug therapy.
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