P4609The use of stellate ganglion block in the management of electrical storm reduces VA burden by 92% and completely excludes the need for general anesthesia

Jiravský, Otakar; Spacek, R; Chovančík, Jan; Szmek, B; Neuwirth, Radek; Hrošová, Martina; Palowski, M; Škňouřil, Libor

doi:10.1093/eurheartj/ehz745.0992

Cited by 2 publications

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“…Their anaesthetic blockade, particularly of the left SG, is used for many indications, for example, in a malignant storm. 5 , 6 The effect of anaesthetic left SG blockade on AP recurrence was demonstrated many years ago. 4 However, a double-blind clinical study showed that the effect on anginal symptoms might be due to mechanical compression caused by the applied volume rather than by anaesthetic properties of the solution.…”

Section: Discussionmentioning

confidence: 99%

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Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report

Hudec

Jiravský

Spacek

et al. 2021

European Heart Journal - Case Reports

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Background Refractory angina pectoris (AP) significantly impairs quality of life in patients with chronic coronary syndrome. Several minimally invasive methods (coronary sinus reducer, cell therapy, laser or shockwave revascularization, and spinal cord stimulation) or non-invasive methods (external counterpulzation) have been studied. However, their routine clinical use has not been widely implemented. Surgical or endoscopic sympathectomy is feasible for permanently relieving angina, but is often contraindicated due to the extent of complications associated with it. Neuromodulation by anaesthetic blockade of the left-sided stellate ganglion (SG) has been shown to relieve angina for days or weeks. To provide a long-term anti-anginal effect, novel pharmacological (phenol-based) or radiofrequency ablation techniques have been individually used to permanently destroy sympathetic pathways. Case summary We describe a first-in-man use of stereotactic radiosurgical SG ablation using a linear accelerator (CyberKnife) in a heart failure patient after myocardial infarction with chronic refractory AP. Repeated anaesthetic SG blockade in this patient resulted in a significant, but only short-term, clinical improvement. The left, and subsequently the right, SG was ablated by targeted irradiation. During the 1-year follow-up, the patient remained without angina. We did not observe any clinically relevant early or late complications. Atrial fibrillation that developed 2 months after the second procedure was deemed to be associated with a natural progression of co-existing heart failure. Discussion We conclude that stereotactic radiosurgical SG ablation has the potential to become a minimally invasive and low-risk procedure to treat refractory angina patients. However, this procedure needs to be evaluated in larger patient populations.

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Section: Discussionmentioning

confidence: 99%

“…At Trinec-Podlesi Hospital, we have been practising anaesthetic puncture blockades of the left SG since 2016 in patients with electrical storm, 5 and in 2018 we expanded the indication to those with refractory angina.…”

Section: Introductionmentioning

confidence: 99%

Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report

Hudec

Jiravský

Spacek

et al. 2021

European Heart Journal - Case Reports

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Ultrasound guided anesthetic stellate ganglion block in treatment of ventricular storm

Jiravský¹,

Špaček²,

Chovančík³

et al. 2020

Intervencni a akutni kardiologie

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Maligní komorová bouře je život ohrožující stav. Rozmach použití implantabilních kardioverterů-defibrilátorů zásadním způsobem zlepšil související mortalitu. Odvrácenou stranou zvyšujícího se počtu implantovaných přístrojů je narůstající počet pacientů s akumulací výbojů pro komorové arytmie. Ovlivnění aktivity sympatiku pomocí blokády ganglion stellatum navigované ultrazvukem přináší možnost zasáhnout do klíčového spouštěcího a zřejmě i udržujícího mechanismu arytmie.Klíčová slova: maligní komorová bouře, ganglion stellatum, komorová tachykardie, fibrilace komor. Ultrasound guided anesthetic stellate ganglion block in treatment of ventricular stormMalignant ventricular storm is a life-threatening condition. The increasing use of implantable cardioverter-defibrillators has significantly improved the related mortality. On the other hand, the increasing number of implanted devices has led to a growing number of patients with ventricular arrhythmias treated with shocks. Altering the activity of the sympathetic system with ultrasound-guided stellate ganglion blockade may target the crucial initiating as well as sustaining mechanisms of ventricular tachyarrhythmia.

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P4609The use of stellate ganglion block in the management of electrical storm reduces VA burden by 92% and completely excludes the need for general anesthesia

Cited by 2 publications

References 0 publications

Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report

Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report

Ultrasound guided anesthetic stellate ganglion block in treatment of ventricular storm

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