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Background and Aims Arrhythmic storms are a life-threatening condition, especially in patients with end-stage heart failure. Stellate ganglion block (SGB) offers sympathetic modulation in refractory cases. We present a case where SGB was used with both diagnostic and therapeutic intent.Methods A 54-year-old male with dilated cardiomyopathy (LVEF 15%), atrial fibrillation on anticoagulation, and cirrhosis with portal hypertension was admitted to the cardiac ICU in an arrhythmic storm. He had an implantable cardioverter-defibrillator placed 3 years prior for primary prevention and 2 other admissions due to an arrhythmic storm. During hospitalization he had several episodes of sustained ventricular tachycardia (VT). Medical therapy failed and catheter ablation was contraindicated due to poor left ventricular access and absence of myocardial fibrosis. A left-sided ultrasound-guided SGB was performed using 5 mL ropivacaine 0.375% and 2 mg dexamethasone, via a lateral in-plane approach ( figure 1), to assess suitability for radiofrequency ablation and achieve temporary arrhythmia control.Results The patient developed ipsilateral Horner’s syndrome (ptosis and miosis) immediately after the block, confirming sympathetic blockade. No arrhythmic episodes occurred in the subsequent 12 hours. Afterwards, the patient remained hospitalized for 2 weeks due to repeated sustained VT with continuous optimization of medical therapy. He was then referred for outpatient radiofrequency ablation of the stellate ganglion.Abstract P085 Figure 1Ultrasound image of left-sided stellate ganglion block. Identifiable structures include the sternocleidomastoid muscle (SCM), longus colli muscle (LCM), carotid artery (CA), internal jugular vein (IJV), and transverse process (TP)Conclusions SGB was an effective and safe approach in this patient with refractory arrhythmic storm, providing both therapeutic benefit and guidance for definitive management. This case highlights the valuable role of regional anesthesia beyond pain management, emphasizing its effectiveness in autonomic modulation of arrhythmias.