Stellate ganglion block for ventricular arrhythmia disease states: Emerging treatment options

Autonomic modulation has emerged as an effective therapeutic target in the management of ventricular arrhythmias and electrical storm (e.g., refractory ventricular arrhythmias), in a background of growing evidence of the link between the autonomic nervous system and arrhythmias. Stellate ganglion blockade (SGB) is a minimally invasive procedure targeting the stellate ganglion with an anesthetic agent that has emerged as a temporizing treatment option for management of refractory and hemodynamically unstable ventricular arrhythmias and electrical storm (ES). SGB which can be performed with fluoroscopy-guidance or at the bedside with anatomic landmark approach or ultrasound guidance, has shown potential efficacy in short-term reduction of arrhythmic burden and termination of electrical storm, based on data from case series and observational studies. In the current review, we highlight the role of the autonomic nervous system in arrhythmogenesis and the clinical applications as well as current limitations and future directions of SGB in management of ventricular arrhythmia and electrical storm.