Stellate ganglion block and cardiac sympathetic denervation in patients with inappropriate sinus tachycardia

Abstract

Background Inappropriate sinus tachycardia (IST) remains a clinical challenge because patients often are highly symptomatic and not responsive to medical therapy. Objective To study the safety and efficacy of stellate ganglion (SG) block and cardiac sympathetic denervation (CSD) in patients with IST. Methods Twelve consecutive patients who had drug‐refractory IST (10 women) were studied. According to a prospectively initiated protocol, five patients underwent an electrophysiologic study before and after SG block (electrophysiology study group). The subsequent seven patients had ambulatory Holter monitoring before and after SG block (ambulatory group). All patients underwent SG block on the right side first, and then on the left side. Selected patients who had heart rate reduction ≥15 beats per minute (bpm) were recommended to consider CSD. Results The mean (SD) baseline heart rate (HR) was 106 (21) bpm. The HR significantly decreased to 93 (20) bpm (P = .02) at 10 minutes after right SG block and remained significantly slower at 97(19) bpm at 60 minutes. Left SG block reduced HR from 99 (21) to 87(16) bpm (P = .02) at 60 minutes. SG block had no significant effect on blood pressure or HR response to isoproterenol or exercise (all P > .05). Five patients underwent right (n = 4) or bilateral (n = 1) CSD. The clinical outcomes were heterogeneous: one patient had complete and two had partial symptomatic relief, and two did not have improvement. Conclusion SG blockade modestly reduces resting HR but has no significant effect on HR during exercise. Permanent CSD may have a modest role in alleviating symptoms in selected patients with IST.

Efficacy and mechanism of stellate ganglion block in patients undergoing carotid endarterectomy

“…It was found that after the implementation of SGB in patients with concomitant blood hyperviscosity syndrome, the patients experienced whole blood hyperviscosity and decreased hematocrit, resulting in accelerated blood circulation. 22 SGB also can increase blood flow velocity, blood flow, and vessel diameter in the anterior middle and posterior cerebral arteries and reduce vascular resistance, 23 which is similar to the findings of this study. In fact, the authors have another hypothesis that SGB may also improve hemodynamic indexes by reducing cerebral vascular resistance in patients with low blood pressure or high TCD velocity, and later the authors intend to conduct a detailed study on this point of view by analyzing the cerebral vascular resistance, ipsilateral or contralateral MCA blood flow velocity in patients after ganglion block.…”

Autonomic control of ventricular function in health and disease: current state of the art

“…Hence, its effects are temporary and reversible. The block can either be achieved as a single injection or through continuous infusion upon placement of a catheter [ 292 , 293 ]. The duration of the block also depends on the half-life of the local anesthetic used, such as bupivacaine or lidocaine.…”

Assessment of the changes in cardiac sympathetic nervous activity using the pupil size changes measured in seated patients whose stellate ganglion is blocked by interscalene brachial plexus block

“…Given that the stellate ganglion synapses with cardiac sympathetic postganglionic fibers [ 4 ], SGB also reduces cardiac sympathetic nervous activity (CSNA). Therefore, SGB has been used as one of the methods for cardiac sympathetic denervation to treat medically refractory arrhythmias driven by enhanced CSNA, such as refractory ventricular arrhythmia, long QT syndrome, and inappropriate sinus tachycardia [ 5 – 7 ]. Usually, arthroscopic shoulder surgery is performed with patients seated because the sitting position provides excellent intra-articular visualization, reduces intraoperative blood loss, decreases the incidence of traction neuropathy, and facilitates the conversion to an open procedure [ 8 ].…”