Time for a new destination: foregoing surgical sympathectomy after successful stellate ganglion block in patients with refractory ventricular tachycardia

Abstract

Abstract Background Electrical storm (ES) is defined as >3 episodes of sustained ventricular arrhythmias in 24 hours and is associated with increased mortality. ES portends a poor prognosis with limited effective treatment options. Stellate ganglion block (STGB) can be used in patients with ES for temporary control of VT. When STGB is successful, patients can be referred for surgical sympathectomy for longer term management. We postulated that STGB can be used as a bridge to other treatments for refractory VT. Purpose To evaluate the efficacy of STGB as a bridge to interventions other than surgical sympathectomy in patients with refractory VT. Additionally, we assessed STGB as an adjunctive therapy to medical optimization when the cause for ES is temporary (e.g., QT prolonging medications, acute ischemia) foregoing the need for long term interventions. Methods This is a single center retrospective study. We enrolled 12 consecutive patients admitted from July 2018 to September 2022 for ES that received a STGB. The primary clinical outcome was cessation of VT for 24 hours beginning 1 hour after STGB was performed. Secondary clinical outcome of the study was freedom from VT until discharge after STGB. Primary safety outcomes were major procedural complications or death within 48 hours after STGB. Results Sixty-seven percent of the patients were male, with a mean age of 58 years and an average left ventricular ejection fraction of 32%. Two-thirds of the patients had ischemic VT of which half were status post CABG and the other half were status post PCI. In the first 24 hours after STGB, 91% of patients were without recurrent VT. Fifty percent of patients did not have recurrent VT from 24 hours after SGB was performed until discharge. Three patients were referred for catheter ablation. No patients received surgical sympathectomy. There were no major complications or deaths within 48 hours of STGB. Conclusion STGB is a safe and effective procedure that can be utilized as a bridge to VT interventions other than surgical sympathectomy. For patients with ES, STGB is also effective at temporarily suppressing VT allowing time for medical optimization and the withdrawal of provoking agents which perpetuate ES. Further research is necessary to determine optimal timing and patient selection for STGB when used as a bridge for alternative VT therapies.Clinical Impact of VT after STGBElectrical Storm Characteristics