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Observational Study
. 2024 Mar 7;45(10):823-833.
doi: 10.1093/eurheartj/ehae021.

Electrical storm treatment by percutaneous stellate ganglion block: the STAR study

Simone Savastano  1 , Enrico Baldi  1 , Sara Compagnoni  1   2 , Roberto Rordorf  1 , Antonio Sanzo  1 , Francesca Romana Gentile  1   2 , Veronica Dusi  3   4 , Simone Frea  3   4 , Carol Gravinese  3   4 , Filippo Maria Cauti  5 , Gianmarco Iannopollo  6 , Francesco De Sensi  7 , Edoardo Gandolfi  8 , Laura Frigerio  8   9 , Pasquale Crea  10 , Domenico Zagari  11 , Matteo Casula  12 , Giuseppe Sangiorgi  13 , Simone Persampieri  14 , Gabriele Dell'Era  15 , Giuseppe Patti  15   16 , Claudia Colombo  17 , Giacomo Mugnai  18 , Francesco Notaristefano  19 , Alberto Barengo  19 , Roberta Falcetti  20 , Giovanni Battista Perego  21 , Giuseppe D'Angelo  22 , Nikita Tanese  22 , Alessia Currao  1 , Vito Sgromo  23 , Gaetano Maria De Ferrari  3   4 ; STAR study group
Collaborators, Affiliations
Observational Study

Electrical storm treatment by percutaneous stellate ganglion block: the STAR study

Simone Savastano et al. Eur Heart J. .

Erratum in

Abstract

Background and aims: An electrical storm (ES) is a clinical emergency with a paucity of established treatment options. Despite initial encouraging reports about the safety and effectiveness of percutaneous stellate ganglion block (PSGB), many questions remained unsettled and evidence from a prospective multicentre study was still lacking. For these purposes, the STAR study was designed.

Methods: This is a multicentre observational study enrolling patients suffering from an ES refractory to standard treatment from 1 July 2017 to 30 June 2023. The primary outcome was the reduction of treated arrhythmic events by at least 50% comparing the 12 h following PSGB with the 12 h before the procedure. STAR operators were specifically trained to both the anterior anatomical and the lateral ultrasound-guided approach.

Results: A total of 131 patients from 19 centres were enrolled and underwent 184 PSGBs. Patients were mainly male (83.2%) with a median age of 68 (63.8-69.2) years and a depressed left ventricular ejection fraction (25.0 ± 12.3%). The primary outcome was reached in 92% of patients, and the median reduction of arrhythmic episodes between 12 h before and after PSGB was 100% (interquartile range -100% to -92.3%). Arrhythmic episodes requiring treatment were significantly reduced comparing 12 h before the first PSGB with 12 h after the last procedure [six (3-15.8) vs. 0 (0-1), P < .0001] and comparing 1 h before with 1 h after each procedure [2 (0-6) vs. 0 (0-0), P < .001]. One major complication occurred (0.5%).

Conclusions: The findings of this large, prospective, multicentre study provide evidence in favour of the effectiveness and safety of PSGB for the treatment of refractory ES.

Keywords: Electrical storm; Neuromodulation; Stellate ganglion block; Ventricular tachycardia.

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Figures

Structured Graphical Abstract
Structured Graphical Abstract
Methods and main findings of the STAR study. ATP, antitachycardia pacing; PSGB, percutaneous stellate ganglion block.
Figure 1
Figure 1
Schematic depiction of the two approaches. On the left, the anterior paratracheal anatomical approach is shown. In the higher part of the left panel, the position of the hand and the site of puncture are illustrated. In the right panel, the later ultrasound-guided approach is shown. In the upper part of the right panel, the ultrasound landmarks are represented, and the yellow star indicates the target zone
Figure 2
Figure 2
The ad-hoc 3D model designed for operators’ training. This model consists of 3D printed anatomical structures (on the left) plunged in an agar-based gel (on the right) which produces the same echogenicity as the human body
Figure 3
Figure 3
Study flow diagram
Figure 4
Figure 4
The per-patient analysis (A) and the per-procedure analysis (B) comparing the number of arrhythmic episodes before and after PSGB. Wilcoxon matched paired signed rank test with resulting P-value is displayed
Figure 5
Figure 5
Subgroup per-procedure analysis providing the comparison of Hodges–Lehmann median differences of the number of ATPs/shocks 1 h before and after PSGB between the different subgroups. Panel (A): anisocoaria vs no anisocora; panel (B): anatomical vs ultrasound-guided approach; panel (C): bolus vs bolus and infusion and panel (D): high volume vs low volume centres
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