Efficacy of early use of percutaneous stellate ganglion block for electrical storms

Abstract

Aims: Electrical storm (ES) is a life-threatening condition requiring a rapid management. Percutaneous stellate ganglion block (PSGB) is proved to be safe and effective on top of standard therapy, but no data are available about its early use.

Methods and results: We considered all patients enrolled from 1 July 2017 to 30 April 2024 in the STAR registry (STellate ganglion block for Arrhythmic stoRm), a multicentre, international, observational, prospective registry. We aimed to assess the effectiveness of the first PSGB only. Patients were divided into two groups depending on whether they received PSGB before [early PSGB, often due to antiarrhythmic drug (AAD) contraindication] or after (delayed PSGB) intravenous AADs (AADs other than beta-blockers). We considered 180 PSGB (26 early PSGB and 154 AAD first). In the early PSGB group, we observed a statistically significant reduction of treated arrhythmic events in the hour after PSGB compared with the hour before: 0 (0-0) vs. 4.5 (1-10), P < 0.001, and the extent of the reduction was similar in the early PSGB and delayed PSGB groups [-4.5 (-7 to -2) vs. -2.5 (-3.5 to -1.5), P = ns]. The percentage of patients free from arrhythmias was similar in the two groups up to 12 h after PSGB (81 vs. 84%, P = 0.6, after 1 h; 77 vs. 79%, P = 0.8, at 3 h; and 65 vs. 69%, P = 0.7, after 12 h).

Conclusion: Percutaneous stellate ganglion block is proved to be effective also when used early in the treatment of ES. Due to its rapidity of action, our results may suggest its early use to reduce the number of defibrillations and possibly to reduce the likelihood of a refractory ES.

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