Elective percutaneous stellate ganglion block for prediction of the clinical outcome of robotic bilateral cardiac sympathetic denervation in a patient with Andersen-Tawil syndrome: A case report

Abstract

Andersen-Tawil syndrome (ATS) is an ultra-rare channelopathy. We report the case of a 35-year-old woman with genetically confirmed ATS. She experienced sudden cardiac arrest. Her medical history was notable for multiple appropriate implantable cardioverter-defibrillator interventions due to ventricular fibrillation and ventricular tachycardia. Numerous premature ventricular contractions were revealed in 24-h Holter ECG monitoring. The arrhythmic episodes were consistently triggered by physical activity, despite multiple antiarrhythmic therapies and two endocardial ablations. A two-step strategy was planned, with the decision to proceed to bilateral cardiac sympathetic denervation (BCSD) based on the outcome of an initial percutaneous stellate ganglion block (PSGB). An elective left-sided percutaneous stellate ganglion block resulted in complete suppression of premature ventricular contractions and improved exercise tolerance. Guided by this response, the patient underwent robotic BCSD, leading to a spectacular reduction of premature beats, disappearance of symptomatic arrhythmias, and normalisation of exercise capacity. No recurrences were observed during the 5-month follow-up. This case is the first to describe elective PSGB as a predictive tool for the efficacy of BCSD in ATS. PSGB may facilitate patient selection for invasive autonomic modulation, offering a novel strategy for refractory inherited channelopathies.