Abstract
BACKGROUND: Electrical storm is a life-threatening condition often requiring antiarrhythmics, sedation, antiadrenergics, and hemodynamic support. In refractory cases, cardiac sympathetic denervation can help reduce arrythmia burden and implantable cardioverter-defibrillator shocks. CASE SUMMARY: A 40-year-old man presented with anteroseptal ST-segment elevation myocardial infarction and newly reduced left ventricular ejection fraction and underwent coronary artery bypass grafting during hospitalization. He subsequently developed refractory monomorphic ventricular tachycardia despite treatment with amiodarone, lidocaine, and a left stellate ganglion block. He was successfully treated with bilateral video-assisted thoracoscopic sympathetic ganglionectomy. DISCUSSION: In patients presenting with electrical storm, particularly those with ischemic cardiomyopathy, bilateral sympathetic ganglionectomy can be an effective treatment when ventricular arrhythmias are refractory to antiarrhythmic drugs and device optimization. TAKE-HOME MESSAGES: This case highlights that bilateral sympathetic ganglionectomy offers more comprehensive autonomic modulation than unilateral block and may provide definitive control of refractory arrhythmias. Temporary blocks may serve as diagnostic or therapeutic bridges to surgical intervention.