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Review
. 2020 Oct 23;22(12):100.
doi: 10.1007/s11906-020-01111-8.

Stellate Ganglion Blockade: an Intervention for the Management of Ventricular Arrhythmias

Arun Ganesh  1 , Yawar J Qadri  2 , Richard L Boortz-Marx  1 , Sana M Al-Khatib  3 , David H Harpole Jr  4 , Jason N Katz  3 , Jason I Koontz  3   5 , Joseph P Mathew  1 , Neil D Ray  1 , Albert Y Sun  3 , Betty C Tong  4 , Luis Ulloa  1   6 , Jonathan P Piccini  3   7   5 , Marat Fudim  8   9
Affiliations
Review

Stellate Ganglion Blockade: an Intervention for the Management of Ventricular Arrhythmias

Arun Ganesh et al. Curr Hypertens Rep. .

Abstract

Purpose of review: To highlight the indications, procedural considerations, and data supporting the use of stellate ganglion blockade (SGB) for management of refractory ventricular arrhythmias.

Recent findings: In patients with refractory ventricular arrhythmias, unilateral or bilateral SGB can reduce arrhythmia burden and defibrillation events for 24-72 h, allowing time for use of other therapies like catheter ablation, surgical sympathectomy, or heart transplantation. The efficacy of SGB appears to be consistent despite the type (monomorphic vs polymorphic) or etiology (ischemic vs non-ischemic cardiomyopathy) of the ventricular arrhythmia. Ultrasound-guided SGB is safe with low risk for complications, even when performed on anticoagulation. SGB is effective and safe and could be considered for patients with refractory ventricular arrhythmias.

Keywords: Stellate ganglion block; Ventricular arrhythmia; Ventricular fibrillation; Ventricular tachycardia.

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Conflict of interest statement

Conflict of Interest The authors declare no conflicts of interest relevant to this manuscript.

Figures

Fig. 1
Fig. 1
Sympathetic innervation to the heart
Fig. 2
Fig. 2
Ultrasound-guided left stellate ganglion block. The yellow line indicates the needle trajectory, and the star is the site of injection. The stellate ganglion resides between the carotid artery and the longus colli muscle at the C7/T1 level. The block is often performed at the C6 level to avoid the vertebral artery. The recurrent laryngeal nerve is not denoted here but is posterior to the thyroid gland, hence why this can be inadvertently blocked when targeting the stellate ganglion. SCM sternocleidomastoid muscle, CA Carotid artery, IJV Internal jugular vein, AS anterior scalene muscle, LC Longus colli muscle, AT Anterior tubercle of C6 vertebrae (Chassaignac’s tubercle)
Fig. 3
Fig. 3
Heat profile of patient before and 10 min after stellate ganglion blockade. From pre to post, there is an increase in the temperature on the forehead and hands, which is used as a surrogate for successful stellate ganglion blockade
Fig. 4
Fig. 4
Duke treatment algorithm for refractory ventricular arrhythmias. Figure modified from Fudim et al. (2020) [12••]. VT ventricular tachycardia, VF ventricular fibrillation
See this image and copyright information in PMC

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