Key result
Sympathetic neural blockade reduces refractory VAs and ICD shocks as an effective adjunct therapy.
Why the study?
Recurrent and refractory ventricular arrhythmias and electrical storm carry substantial morbidity and mortality despite advances in therapy, prompting a review of clinical evidence for sympathetic neural blockade.
Does sympathetic neural blockade reduce ventricular arrhythmia episodes and ICD shocks in patients with refractory ventricular arrhythmias and electrical storm?
Does sympathetic neural blockade reduce ventricular arrhythmia episodes and ICD shocks in patients with refractory ventricular arrhythmias and electrical storm?
Sympathetic neural blockade, particularly stellate ganglion block, is an effective adjunct therapy for refractory ventricular arrhythmias and electrical storm.
Sympathetic neural blockade merits consideration for refractory ventricular arrhythmias; extends autonomic modulation evidence beyond ablation and pharmacotherapy.
Purpose of review To review and summarize the current clinical evidence supporting sympathetic neural blockade for recurrent and refractory ventricular arrhythmias and electrical storm. These conditions continue to be associated with substantial morbidity and mortality, despite advances in antiarrhythmic therapy, catheter ablation, and mechanical circulatory support. Sympathetic overactivity is a key driver of ventricular arrhythmogenesis, and cardiac autonomic neuromodulation should be recognized as an important tool in the therapeutic algorithms. Recent findings Clinical evidence and acceptance of percutaneous and neuraxial sympathetic blockade for ventricular tachyarrhythmias and electrical storm are rapidly accumulating. A dramatic increase in the amount of peer-reviewed publications indicates a transition from emergence and recognition to mainstream adoption and consolidation phases. Currently, most reports and strongest evidence support percutaneous stellate ganglion block (SGB), associated with rapid reductions in ventricular arrhythmia episodes and implantable cardioverter defibrillator shocks across systematic reviews and multicenter observational studies. Continuous block techniques may prolong benefit beyond a single-injection. Thoracic epidural anesthesia has also demonstrated clinically meaningful arrhythmia suppression, while evidence for thoracic paravertebral and proximal intercostal blocks is accumulating. Summary Sympathetic neural blockade is a clinically effective adjunct therapy for refractory ventricular arrhythmias, with SGB currently supported by the strongest clinical evidence.
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Gerner et al. (2026) conducted a review in Recurrent and refractory ventricular arrhythmias and electrical storm. Sympathetic neural blockade (including stellate ganglion block) was evaluated. Sympathetic neural blockade, particularly percutaneous stellate ganglion block, is a clinically effective adjunct therapy for reducing refractory ventricular arrhythmias and defibrillator shocks.
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