Percutaneous stellate ganglion block reduced arrhythmic events effectively in 82-89% of patients within one hour, regardless of LVEF or heart disease type.
Does percutaneous stellate ganglion block reduce ventricular arrhythmias requiring shock or ATP in patients with electrical storm, regardless of underlying heart disease and LVEF?
Percutaneous stellate ganglion block is highly effective at suppressing arrhythmic storms and reducing shocks/ATP, with consistent efficacy regardless of baseline LVEF, underlying heart disease, or the presence of shock.
Absolute Event Rate: 0% vs 0%
Abstract Background The relationship between the sympathetic nervous system and ventricular arrhythmias (VAs) which characterize patients with heart disease has been widely demonstrated. PSGB proved to be safe and effective in the treatment of arrhythmic storms (AS). Purpose The aim of our study is to understand whether PSGB safety and effectiveness are influenced by the type of the underlying heart disease and the degree of left ventricular dysfunction. Materials and methods This analysis included the PSGB procedures performed from July 1, 2017 to April 30, 2024 in the 19 Italian centres participating in the STAR project, a multicentre registry. As first, procedures were divided into three groups based on the tertiles of left ventricular ejection fraction (LVEF) before the procedure (T1: LVEF 20%; T2: LVEF 20%-33%; T3: LVEF 33%); then, patients were categorized based on the type of heart disease and the presence of shock (cardiogenic or septic). We compared the number of VAs treated with shock (external or internal) or anti-tachycardia pacing (ATP) before and after the PSGB procedure. Results From a total of 254 PSGB procedures, pre-procedure LVEF data were available for 244 cases T1: 84 (34%); T2: 82 (34%); T3: 78 (32%). Within the first hour after PSGB, the rate of complete arrhythmic suppression was similar among groups (T1: 82%, T2: 86%, T3: 89%, p=0.39) and PSGB led to a significant reduction in the number of shocks/ATP T1: 2 (1–3) vs. 0 (0–0), p0.01; T2: 2 (1–3) vs. 0 (0–0), p0.01; T3: 2 (1–4) vs. 0 (0–0), p0.01, with the extent of reduction being similar among groups. LVEF was not associated with the likelihood of complete arrhythmic suppression T1: reference; T2: OR 1.4 (95% CI: 0.6–3.2), p=0.45; T3: OR 1.9 (95% CI: 0.7–4.7), p=0.18. A total of 180 patients were treated, 53 with acute coronary syndrome (ACS), 67 with ischemic cardiopathy (IC), 41 with non-ischemic cardiomyopathy (NIC), and 19 with other conditions (myocarditis, toxic drug/substance effects, unknown); 48 had cardiogenic or septic shock. PSGB was effective in all groups considering the three major groups of heart disease and also in the presence of septic shock. The proportion of patients free from arrhythmias was similar across the groups within the 12 hours following the procedure (ACS: 57%, IC: 69%, NIC: 68%, p=0.3). Neither the heart disease ACS: ref; IC: OR 2.1 (0.9-4.9), p=0.09; NIC: OR 1.6 (0.7-3.9), p=0.3 nor the presence of shock OR 2.1 (0.9-4.9), p=0.08 were significantly associated with the likelihood of complete arrhythmia suppression in the 12 hours after PSGB at multivariate analysis. Conclusions Our study confirms that PSGB is an effective technique for treating arrhythmic storms, regardless of the degree of left ventricular dysfunction, the underlying heart disease and the presence of shock.
Citterio et al. (Sat,) reported a other. Percutaneous stellate ganglion block reduced arrhythmic events effectively in 82-89% of patients within one hour, regardless of LVEF or heart disease type.