Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm

Abstract

Background: Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. Methods: This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. Results: Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P =0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB ( P <0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P =0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P =0.009). There were no procedure-related major complications. Conclusions: SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.

Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias

“…Sympathetic denervation has shown to relieve electrical storm suggesting sympathetic activation may play an important role in occurrence of ventricular fibrillation 19 – 21 and prior studies demonstrated that sympathetic nervous system is activated in AF patients and has critical role in AF development 22 . Furthermore, AF is associated with significant patient discomfort which might activate sympathetic tone 2 , 23 .…”

Stellate ganglion block reduces symptoms of Long COVID: A case series

“…The ability of the SGB to improve blood flow and deactivate sympathetic tone has also been useful in the treatment of Raynaud's phenomenon and hyperhidrosis in the upper limbs ( Rickles, 1977 ). Currently SGB is showing promise for treatment of post-traumatic stress disorder ( Lipov et al, 2012 ; Mulvaney et al, 2014 ), cardiac arrhythmia ( Tian et al, 2019 ), and hot flashes associated with cancer treatment and menopause ( Othman and Zaky, 2014 ; Rahimzadeh et al, 2018 ). Mechanisms for the durable central nervous system effects of the SGB in these conditions are unclear, delaying its broad acceptance as a valid treatment.…”

Autonomic Modulation for Treatment of Repolarization Alternans and Refractory Ventricular Electrical Storm

“…The role of unilateral left sided vs bilateral SGB continues to evolve. Prospective analyses have shown similar efficacy between the 2 ( 9 ). Although the left-sided SGB has been shown to reduce ventricular fibrillation threshold following myocardial infarction, functional asymmetry of the stellate ganglia suggest a role of the right stellate ganglion in influencing heart rate and arrhythmia vulnerability.…”