Left Stellate Ganglion Block for Refractory Ventricular Tachycardia: A Case Series

Ventricular arrhythmias are usually well controlled with medical management, cardiac implantable electronic devices, or catheter ablation. However, the refractory ventricular tachycardia or fibrillation (VT/VF) is life threatening and challenging. The authors reported a case series of left stellate ganglion blocks (LSGB) in patients with refractory VT/VF, who failed pharmacological treatment and multiple traditional cardiac interventions. Five patients underwent six LSGB. Four patients had significant decreased in ventricular arrhythmia burden. Among the responders, the LSGB suppressed significant VT/VF for three to seven days. Blocks did not only temporary suppress ventricular arrhythmia, but also stabilized the condition and served as a bridge to definitive treatment such as EP ablation or heart transplantation. There was no significant hemodynamic change or devastating side effects. The outcome from the present case series suggested that LSGB could be an effective treatment and a lifesaving intervention frintractable VT/VF. Keywords: Stellate ganglion block, Refractory ventricular tachycardia, Sympathectomy

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Left stellate ganglion block, a rescue treatment for ventricular arrhythmia refractory to radiofrequency catheter ablation

Medicine ◽

10.1097/md.0000000000017790 ◽

2019 ◽

Vol 98 (44) ◽

pp. e17790 ◽

Cited By ~ 1

Author(s):

Shih-Chieh Yang ◽

Chih-Cheng Wu ◽

Yun-Jui Hsieh

Keyword(s):

Catheter Ablation ◽

Ventricular Arrhythmia ◽

Radiofrequency Catheter Ablation ◽

Stellate Ganglion ◽

Stellate Ganglion Block ◽

Ganglion Block ◽

Rescue Treatment ◽

Left Stellate Ganglion

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Anatomical-based percutaneous left stellate ganglion block in patients with drug-refractory electrical storm and structural heart disease: a single-centre case series

EP Europace ◽

10.1093/europace/euaa319 ◽

2020 ◽

Author(s):

Simone Savastano ◽

Veronica Dusi ◽

Enrico Baldi ◽

Roberto Rordorf ◽

Antonio Sanzo ◽

...

Keyword(s):

Stellate Ganglion ◽

Case Series ◽

Stellate Ganglion Block ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Electrical Storm ◽

Ganglion Block ◽

Ventricular Ejection Fraction ◽

Left Stellate Ganglion ◽

Stellate Ganglion Blockade

Abstract Aims The adoption of percutaneous stellate ganglion blockade for the treatment of drug-refractory electrical storm (ES) has been increasingly reported; however, the time of onset of the anti-arrhythmic effects, the safety of a purely anatomical approach in conscious patients and the additional benefit of repeated procedures remain unclear. Methods and results This study included consecutive patients undergoing percutaneous left stellate ganglion blockade (PLSGB) in our centre for drug-refractory ES. Lidocaine, bupivacaine, or a combination of both were injected in the vicinity of the left stellate ganglion. Overall, 18 PLSGBs were performed in 11 patients (age 69 ± 13 years; 63.6% men, left ventricular ejection fraction 31.6 ± 16%). Seven patients received only one PLSGB; three underwent two procedures and one required three PLSGB and two continuous infusions to control ventricular arrhythmias (VAs). All PLSGBs were performed with an anatomical approach; lidocaine, alone, or in combination was used in 77.7% of the procedures. The median burden of VAs 1 h after each block was zero compared with five in the hour before (P < 0.001); 83% of the patients were free from VAs; the efficacy at 24 h increased with repeated blocks. The anti-arrhythmic efficacy of PLSGB was not related to anisocoria. No procedure-related complications were reported. Conclusion Anatomical-based PLSGB is a safe and rapidly effective treatment for refractory ES; repeated blocks provide additional benefits. Percutaneous left stellate ganglion blockade should be considered for stabilizing patients to allow further ES management.

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P4609The use of stellate ganglion block in the management of electrical storm reduces VA burden by 92% and completely excludes the need for general anesthesia

European Heart Journal ◽

10.1093/eurheartj/ehz745.0992 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

O Jiravsky ◽

R Spacek ◽

J Chovancik ◽

B Szmek ◽

R Neuwirth ◽

...

Keyword(s):

General Anesthesia ◽

Stellate Ganglion ◽

Case Series ◽

Stellate Ganglion Block ◽

Electrical Storm ◽

Ultrasound Guided ◽

Ganglion Block ◽

Threatening Condition ◽

Life Threatening ◽

Antiarrhythmic Treatment

Abstract Background The electrical ventricular storm (ES) is a life-threatening condition. The treatment is based on addressing the triggering cause, influencing reversible factors, patient sedation, and antiarrhythmics. Suppressing the massive sympathetic surge is a keystone in the emergent management. Stellate ganglion block (SGB) might serve this purpose. Purpose To show the efficacy of ultrasound-guided SGB in the management of ES. Methods Retrospective analysis of case series. All ES patients in whom SGB was used. SGB was performed after the initial failure of reversible factors modification + sedation + antiarrhythmics. We compared the mean VA burden 2 days before vs. 7 days after SGB (to show the long effect of SGB). 31 patients (5 females). Procedure date between 01.03.2017 and 21.11.2018. Mean LVEF 27±9%. Etiology: 74% ischemic vs. 26% non-ischemic cardiomyopathy. Antiarrhythmic treatment: amiodarone 27 pt. (87%), trimecaine 3pt (10%), digoxin 2 pt. (6%), beta-blocker 28 pt. (90%). Results The ES management including SGB resulted in a significant decrease (92%) in VA burden (mean 26,0 episodes/day vs. 0,6 episodes/day; p<0.001). Separately, ATP episodes were reduced by 99%, external or ICD shocks by 76%. There was no need for general anesthesia as a last resort in refractory ES. 30-days mortality 12,9%. No significant adverse events have been noticed, 10 pt. (32,3%) have developed Horner syndrome, which always disappeared in 24 hours. Conclusion Ultrasound-guided SGB in the management of ES is safe and very effective. Randomized prospective studies are required to precisely determine the effect of SGB.

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Percutaneous stellate ganglion block in the treatment of incessant ventricular tachycardia and ventricular fibrillation

In a good rythm ◽

10.5604/01.3001.0012.0394 ◽

2018 ◽

Vol 2 (47) ◽

pp. 22-26

Author(s):

Marcin Chlebuś ◽

Janusz Romanek ◽

Włodzimierz Wnęk ◽

Andrzej Przybylski

Keyword(s):

Ventricular Tachycardia ◽

Myocardial Dysfunction ◽

Stellate Ganglion ◽

Stellate Ganglion Block ◽

Surgical Excision ◽

Electrical Storm ◽

Circulatory Support ◽

Adrenergic Stimulation ◽

Ganglion Block ◽

Life Threatening

Treatment of ventricular arrhythmias, especially electrical storm or incessant ventricular tachycardia (VT), remains a therapeutic challenge due to the limited possibilities of pharmacotherapy. The possibility of electrophysiological diagnostics and ablation of the arrhythmic substrate allows to effectively prevent the recurrence of VT. Often, though, a serious general condition of the patient and the progress of myocardial dysfunction prevents from conducting an effective ablation procedure. The method that can interrupt an electric storm or incessant VT is the blockade of the sympathetic nervous system, which is responsible for the adrenergic stimulation of the heart. This is achievable by blocking the stellate ganglion (SGB). The cases of sympathetic denervation described in the literature include cases of surgical excision of the ganglion or percutaneous block with the use of anesthetics. The use of SGB enables the termination of life-threatening arrhythmias and improvement of the patient’s clinical condition, which is often a prerequisite for administering electrophysiological treatment or transferring the patient to a center having the capability to apply mechanical circulatory support.

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Current and investigational therapies for the treatment of refractory ventricular fibrillation

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxac011 ◽

2022 ◽

Author(s):

Nicholas Scaturo ◽

Eileen Shomo ◽

Marshall Frank

Keyword(s):

Ventricular Fibrillation ◽

Case Reports ◽

Stellate Ganglion ◽

Case Series ◽

Stellate Ganglion Block ◽

Treatment Modalities ◽

Supporting Evidence ◽

Ganglion Block ◽

Left Stellate Ganglion ◽

Safety Considerations

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Esmolol, dual sequential defibrillation, vector change defibrillation, and left stellate ganglion block are presented and reviewed for the treatment of refractory ventricular fibrillation. Summary Although no formal definition has been established for refractory ventricular fibrillation, the literature describes it as a pulseless ventricular arrhythmia that persists despite 3 standard defibrillation attempts, administration of amiodarone 300 mg intravenously, and provision of three 1-mg intravenous doses of epinephrine. Evolving literature surrounding resuscitation in this particular subset of cardiac arrest challenges the efficacy of traditional therapies, such as epinephrine, and suggests that other treatment modalities may improve outcomes. Case reports, case series, and small retrospective studies have pointed to benefit when utilizing a variety of therapies, namely, esmolol, dual sequential defibrillation, vector change defibrillation, or left stellate ganglion block, in patients with refractory ventricular fibrillation arrest. Conclusion A mounting, although limited, body of evidence suggests that esmolol, dual sequential defibrillation, vector change defibrillation, or left stellate ganglion block may be effective at terminating refractory ventricular fibrillation and improving patient outcomes. Further evidence is required before these therapies can be adopted as standard practice; however, as key members of the code response team, it is imperative for pharmacists to be familiar with the supporting evidence, safety considerations, and logistical challenges of utilizing these treatments during arrest.

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