Abstract 16745: Continuous Stellate Ganglion Block for Ventricular Arrhythmias: Case Series, Systematic Review and Comparison With Epidural Anesthesia

Abstract

Background: Percutaneous single bolus injection left stellate ganglion block (PLSGB) and thoracic epidural anesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). Data on continuous PLSGB (C-PLSGB) are scant. Objectives: to report our single center experience with C-PLSGB and perform a systematic review on C-PLSGB and TEA to preliminary compare these 2 techniques. Methods: consecutive patients receiving C-PLSGB were enrolled. The systematic literature review was performed following the latest PRISMA criteria. Results: our single-center case series (8 pts, 88% male, 60 ±16 years, all with structural heart disease) supports that C-PLSGB is feasible and safe, even on fully anticoagulated patients and leads to a complete VAs suppression in half and to an overall clinical benefit in all patients. Overall, considering previously published data, 34 patients received C-PLSGB, and 18 TEA for refractory VAs. Most (61%) in the TEA group were on general anesthesia, as opposed to 24% in the C-PLSGB group (p=0.01); 52% of patients were on full anticoagulation at C-PLSGB, none at TEA (p<0.01). C-PLSGB and TEA efficacy was not significantly different (31/34 versus 13/18 had a complete or at least partial response, p=0.1). No major complications occurred, yet the discontinuation rate was significantly higher in the TEA compared to C-PLSGB (22% versus 3%, p=0.037). Conclusions: C-PLSGB seems feasible, safe and effective for the acute management of refractory VAs. C-PLSGB efficacy seems to be not significantly different to that of TEA and may be accomplished with less concerns of anticoagulation, and lower discontinuation rate.