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Stellate Ganglion Blockade for VT/VF
Study Questions:
Is stellate ganglion blockade (SGB) helpful for the treatment of refractory sustained ventricular tachycardia (VT) and ventricular fibrillation (VF)?
Methods:
This was a retrospective analysis of 20 consecutive patients (19 males, mean age 58 years, ejection fraction ≤35% in 80%) with drug-refractory VT/VF who underwent bilateral, ultrasound-guided, temporary SGB using lidocaine, bupivacaine, or ropivacaine. Ten patients were receiving inotropic support and nine were receiving mechanical circulatory support. The primary outcome was the number of episodes of VT/VF in the 24 and 48 hours before and after SGB.
Results:
The median number of episodes of VT/VF decreased from 4.5 in the 24 hours before SGB to 0 in the 24 hours after SGB. The median number of defibrillations during the same periods of time were 2.5 before and 0 after SGB. Nine of the 20 patients (45%) had no episodes of VT during the 48 hours post-SGB and 20% had no further VT/VF episodes during the remainder of the hospitalization. The only complication of SGB was laryngeal nerve paresis in one patient.
Conclusions:
SGB is safe and effective for the treatment of patients with drug-refractory and frequent episodes of VT/VF.
Perspective:
An increase in sympathetic tone often plays an important role in triggering and/or maintaining electrical storms. This explains the efficacy of pharmacological beta-blockade, general anesthesia, and surgical sympathectomy demonstrated in prior studies. A recent report also demonstrated the efficacy of SGB in patients with an electrical storm. The present study confirms that this minimally invasive and safe technique is a valuable addition to the limited number of options currently available for the treatment of these difficult-to-manage patients.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Anesthesia, General, Arrhythmias, Cardiac, Autonomic Nerve Block, Bupivacaine, Electric Countershock, Heart Failure, Laryngeal Nerves, Lidocaine, Paresis, Stellate Ganglion, Stroke Volume, Sympathectomy, Tachycardia, Ventricular, Ventricular Fibrillation
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