Stellate Ganglion Blockade for the Treatment of Refractory Ventricular Arrhythmias.

Abstract

This study sought to describe our institutional experience with establishing a neurocardiology service in an attempt to provide autonomic modulation as a treatment for ventricular arrhythmias (VAs). Treatment-refractory VAs are commonly driven and exacerbated by heightened sympathetic tone. Among patients referred to the neurocardiology service (August 2016 to December 2018), we performed ultrasound-based, bilateral, temporary stellate ganglion blockade (SGB) in 20 consecutive patients. We analyzed outcomes of interest including sustained VA or VA requiring defibrillation in the 24 and 48h before and 24 and 48h afterSGB. The majority of patients were men (n=19, 95%), with a mean age of 58 ± 14 years. At the time of SGB, 10(50%) were on inotropic support and 9 (45%) were on mechanical circulatory support. Besides 1 case of hoarseness, there were no apparent procedural complications. SGB was associated with a reduction in the number of VA episodes from the 24h before (median 5.5 [interquartile range (IQR): 2.0 to 15.8]) to 24h after SGB (median 0 [IQR: 0 to 3.8]) (p<0.001). The number of defibrillation events decreased from 2.5 (IQR: 0 to 10.3) to 0 (IQR: 0 to 2.5) (p=0.002). Similar findings were observed over the 48-h period before and after the SGB. Overall, 9 of 20 (45%) patients had a complete response with no recurrence of ventricular tachycardia (VT) or ventricular fibrillation (VF) for 48h after SGB. Four (20%) patients had no recurrent VT or VF following SGB through discharge. Similar response rates were observed in those with ischemic (median 6 [IQR: 1.8 to 18.8] to 0.5 [IQR: 0 to 5.3] events; p=0.031) and nonischemic (median 3.5 [IQR: 1.8 to 6.8] to 0 [IQR: 0 to 1.3] events; p=0.012) cardiomyopathy. Minimally invasive, ultrasound-guided bilateral SGB appears safe and provides substantial reductioninVA burden with approximately 1 in 2 patients exhibiting complete suppression of VT or VF for 48 h.