TEE-Guided Percutaneous Aspiration of a Large Lead-Associated Vegetation Prior to Transvenous Lead Extraction.

• Vacuum-assisted aspiration of large CIED lead vegetations is a promising technology. • TEE guidance is critical for the safe and complete aspiration of vegetations. • Real-time TEE identifies important residual findings following lead extraction.

Stellate ganglion blockade and bilateral cardiac sympathetic denervation in patients with life-threatening ventricular arrhythmias.

Autonomic modulation is being increasingly employed as a strategy to treat ventricular arrhythmias refractory to beta-blockers, antiarrhythmic drugs, and catheter-based ablation procedures. We report 6 patients with refractory ventricular tachycardia (VT) or ventricular fibrillation (VF) treated with stellate ganglion blockade (SGB) and/or bilateral cardiac sympathetic denervation (CSD). Our case series emphasizes the concept that the cardiac sympathetic nerves are important targets in the management of ventricular arrhythmias.