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Stellate Ganglion Block for Refractory Ventricular Arrhythmias
Quick Takes
- Stellate ganglion blockade (SGB) is a simple bedside procedure temporizing treatment for refractory ventricular arrhythmias.
- In a registry study, SGB use was associated with a reduction in the burden of ventricular arrhythmia and the need for electrical cardioversion.
Study Questions:
What are the outcomes of the stellate ganglion block (SGB) with respect to recurrence of ventricular tachycardia/ventricular fibrillation (VT/VF)?
Methods:
The authors analyzed outcomes of patients treated for refractory ventricular arrhythmia at two clinical sites. SGB was performed at bedside by anesthesiologists and/or cardiologists.
Results:
There were 117 patients with refractory ventricular arrhythmias treated with SGB. The most common etiology of heart disease was ischemic cardiomyopathy (52%). Monomorphic VT was the most common morphology (70%). Within 24 hours prior to SGB, the median episodes of VT/VF were 7.5 (interquartile range [IQR], 3–27) and 24 hours after SGB, the median decreased to 1.0 (IQR, 0–4.5; p < 0.001). Twenty-four hours prior to SGB, the median defibrillation events were 2.0 (IQR, 0–8) and 24 hours after SGB, the median decreased to 0 (IQR, 0–1; p < 0.001).
Conclusions:
The authors conclude that in patients with treatment-refractory ventricular arrhythmia, SGB was associated with a reduction in the ventricular arrhythmia burden and need for defibrillation.
Perspective:
Autonomic tone contributes to the initiation of ventricular arrhythmias. Beta-blockers, antiarrhythmic agents, and sedation are established treatments for refractory VT/VF in the setting of electrical storm. Use of ablation procedure is limited by hemodynamic status. Likewise, surgical sympathectomy is effective in reducing VT/VF in some patient cohorts when hemodynamically stable. In this manuscript, the authors show that percutaneous SGB can be helpful in temporary, but significant ventricular arrhythmia burden reduction. SBG can be performed at the bedside with ultrasound guidance and local anesthetic. Bilateral SGB was not required for successful ventricular arrhythmia suppression. These findings require future research with a control group. SBG is being evaluated in an ongoing prospective randomized trial.
Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias
Keywords: Stellate Ganglion, Tachycardia, Ventricular, Ventricular Fibrillation
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