Does temporary percutaneous stellate ganglion block reduce VA burden and defibrillation episodes in patients with treatment-refractory ventricular arrhythmias?
Temporary percutaneous stellate ganglion block is associated with an acute reduction in ventricular arrhythmia burden and defibrillation episodes in patients with refractory VAs.
INTRODUCTION: Treatment refractory ventricular arrhythmias (VAs) are often driven and exacerbated by heightened sympathetic tone. We aim to conduct a systematic review and meta-analysis of published studies of a temporary percutaneous stellate ganglion block (SGB) on VA burden and defibrillation episodes in patients with treatment refractory VAs. METHODS: Relevant studies from January 1960 through May 2017 were identified in PubMed and Google Scholar. We performed a patient-level analysis using Student's t-test to compare outcomes before and after SGB. RESULTS: We identified 22 unique case series with a total of 35 patients. Patients were 57 ± 17 years old and 69% were males with a high burden of VA. A unilateral (left)-sided SGB was used in 85.7% (30 of 35) of cases and the remaining were bilateral SGB. The use of a unilateral or bilateral SGB resulted in a significant reduction of VA episodes (24-hours pre: mean 16.5 CI 9.7-23.1 events vs. post: mean 1.4 CI 0.85-2.01 events; P = 0.0002) and need for defibrillation (24-hours pre: mean 14.2 CI 6.8-21.6 vs. post: mean 0.6 CI 0.3-0.9; P = 0.0026). Furthermore, SGB was significantly associated with a reduction of VA burden regardless of etiology of cardiomyopathy, type of ventricular rhythm, and degree of contractile dysfunction. SGB was followed by surgical sympathectomy in 21% of cases. CONCLUSIONS: Early experience suggests that SGB is associated with an acute reduction in the VA burden and offers potential promise for a broader use in high-risk populations. Randomized controlled studies are needed to confirm the safety and efficacy of this therapy.
Fudim et al. (Fri,) studied this question.