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Multicenter Study
. 2024 Apr;10(4):750-758.
doi: 10.1016/j.jacep.2023.12.012. Epub 2024 Feb 14.

A Multicenter Study of Stellate Ganglion Block as a Temporizing Treatment for Refractory Ventricular Arrhythmias

Fouad Chouairi  1 , Karuna Rajkumar  2 , Ales Benak  3 , Yawar Qadri  4 , Jonathan P Piccini  5 , Joseph Mathew  6 , Neil D Ray  6 , Jakub Toman  3 , Josef Kautzner  3 , Arun Ganesh  6 , Marek Sramko  3 , Marat Fudim  7
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Free article
Multicenter Study

A Multicenter Study of Stellate Ganglion Block as a Temporizing Treatment for Refractory Ventricular Arrhythmias

Fouad Chouairi et al. JACC Clin Electrophysiol. 2024 Apr.
Free article

Abstract

Background: Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions and can be refractory to conventional drug and device interventions. Stellate ganglion blockade (SGB) has been described as an adjunct, temporizing intervention in patients with refractory ventricular arrhythmia. We examined the association of SGB with VT/VF in a multicenter registry.

Objectives: This study examined the efficacy of SGB for treatment/temporization of refractory VT/VF.

Methods: The authors present the first analysis from a multicenter registry of patients treated for refractory ventricular arrhythmia at a clinical site in the Czech Republic and the United States. Data were collected between 2016 and 2022. SGB was performed at the bedside by anesthesiologists and/or cardiologists. Outcomes of interest were VT/VF burden and defibrillations at 24 hours before and after SGB.

Results: In total, there were 117 patients with refractory ventricular arrhythmias treated with SGB at Duke (n = 49) and the Institute for Clinical and Experimental Medicine (n = 68). The majority of patients were male (94.0%), were White (87.2%), and had an implantable cardioverter-defibrillator (70.1%). The most common etiology of heart disease was ischemic cardiomyopathy (52.1%), and monomorphic VT was the most common morphology (70.1%). Within 24 hours before SGB (0-24 hours), the median episodes of VT/VF were 7.5 (Q1-Q3: 3.0-27.0), and 24 hours after SGB, the median decreased to 1.0 (Q1-Q3: 0.0-4.5; P < 0.001). At 24 hours before SGB, the median defibrillation events were 2.0 (Q1-Q3: 0.0-8.0), and 24 hours after SGB, the median decreased to 0.0 (Q1-Q3: 0.0-1.0; P < 0.001).

Conclusions: In the largest cohort of patients with treatment-refractory ventricular arrhythmia, we demonstrate that SGB use was associated with a reduction in the ventricular arrhythmia burden and need for defibrillation therapy.

Keywords: electrical storm; stellate ganglion block; ventricular arrhythmias.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Piccini is a consultant for Abbott, Biotronik, Boston Scientific, Medtronic, and Philips; has received grants for clinical research from Abbott, the American Heart Association, Boston Scientific, and Philips; and is supported by R01AG074185 from the National Institutes of Aging. Dr Fudim has been supported by the American Heart Association (20IPA35310955), Doris Duke, and Bodyport and has received consulting fees from Abbott, Boston Scientific, Presidio, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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