Use of Atrial Septostomy to Treat Severe Pulmonary Arterial Hypertension in Adults.

6 patients, the number of arrhythmia episodes declined during the first 24 hours after the initiation of sympathetic blockade (Figure). In all 6 patients, LSGB significantly reduced the total number of episodes and the number of episodes in the first 24 hours after the intervention (P < .05). Electrical storm recurred in 3 patients (37%) during the first 24 hours after the cessation of sympathetic blockade. Of these patients, 2 responded to repeat LSGB. The third patient responded to conventional therapy and thus there was no further requirement for sympathetic blockade. Mortality was 50% (patients 2, 3, 6, and 8), but only 1 death (patient 6) was due to arrhythmia. Catheter ablation of ventricular tachycardia was performed in patient 4, and patient 5 underwent heart transplantation. The follow-up of each patient is presented in the Table. In all patients, sympathetic blockade was transitory and its use did not interfere with conventional treatments, including definitive treatments such as catheter ablation and heart transplantation. There were no complications related to the procedure. The results of our study suggest that TSB is a useful technique for the control of refractory ES. In our study, we used standard techniques for transient sympathetic blockade without having to resort to definitive methods. This contrasts with other studies reporting the use of interventions such as surgical sympathecto-my 5 or videothoracoscopy ablation of the sympathetic chain ganglia in the pleural cavity. The main limitations of our study are the small sample size and its observational and retrospective nature. In addition, due to patient care and organizational issues, it was not possible to retrospectively determine the exact number of patients presenting with refractory ES during the study period storm: sympathetic blockade versus advanced cardiac life support-guided therapy. Use of thoracic epidural anesthesia for management of electrical storm: a case report. modulation for refractory ventricular arrhythmias: value of thoracic epidural anesthesia and surgical left cardiac sympathetic denervation. Septostomı´a auricular en el tratamiento de la hipertensión arterial pulmonar grave del adulto To the Editor, Elective atrial septostomy (AS) can provide additional clinical benefits to adults receiving targeted triple therapy (endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prosta-noids) for severe pulmonary arterial hypertension (PAH). Elective AS can be used as a bridge to lung transplantation when medical treatment is ineffective or as a definitive treatment when transplantation is contraindicated. Clinical guidelines recommend AS for PAH patients in functional class III or IV with …