Stellate Ganglion Block to Increase Defibrillation Effectiveness in Acute Fulminant Myocarditis-Induced Refractory Ventricular Fibrillation

Background: Percutaneous left stellate ganglion block (PLSGB) is used to prevent ventricular arrhythmia recurrences in various settings. Clinical data on its impact on ventricular fibrillation (VF) defibrillation threshold are scant and limited to acute coronary syndromes. Case Summary: We present a case of refractory VF in acute fulminant myocarditis. Despite multiple drugs and hemodynamic mechanical support, the VF was unresponsive to several DC shock attempts, including double sequential and vector change defibrillation. PLSGB allowed stable sinus rhythm restoration. Discussion: PLSGB was performed to enhance the success of DC shock, highlighting the importance of acute neuromodulation strategies not only to prevent ventricular arrhythmia recurrences but also to improve defibrillation effectiveness. Our case is the first reported PLSGB usage in acute fulminant myocarditis-induced refractory VF.