Key result
Percutaneous SGB and BCSD linked to reducing sustained ventricular arrhythmias to a median of ~0.
Why the study?
Increasing evidence suggests that stellate ganglion block and bilateral cardiac sympathetic denervation produce sustained cessation of refractory arrhythmic storms, but their long-term efficacy and safety require evaluation.
Does ultrasound-guided percutaneous stellate ganglion block and bilateral cardiac sympathetic denervation reduce sustained ventricular arrhythmias in patients with refractory arrhythmic storm?
Cohort (n=18)
No
Does ultrasound-guided percutaneous stellate ganglion block and bilateral cardiac sympathetic denervation reduce sustained ventricular arrhythmias in patients with refractory arrhythmic storm?
Ultrasound-guided percutaneous bilateral cardiac sympathetic denervation significantly reduces ventricular arrhythmias and provides stabilization for up to 12 months in patients with refractory arrhythmic storm.
May reduce sustained ventricular arrhythmias in refractory storm; leaves open confirmation of benefit and safety in randomized trials.
Objectives Increasing evidence suggests that stellate ganglion block (SGB) and bilateral cardiac sympathetic denervation (BCSD) produce a sustained cessation of refractory arrhythmic storms. This study aimed to evaluate the efficacy and safety of ultrasound-guided percutaneous SGB and BCSD in patients with refractory arrhythmic storm. Design Prospective observational cohort study. Setting Single-center tertiary hospital. Participants All consecutive patients undergoing SGB and BCSD for refractory electrical storm (April 2023 to September 2024) were included. Interventions For BCSD, 2 conventional radiofrequency lesions were created, followed by levobupivacaine infiltration. Measurements and Main Results The primary outcome was the change in sustained ventricular arrhythmias over a period of 12 months. Eighteen patients were enrolled; fifteen completed follow-up. A significant reduction in sustained ventricular arrhythmias and implanted device shocks/ablations was observed within 24 hours after SGB, with temporary stabilization for nearly 12 months after BCSD (median [interquartile range], 4 [2-7.5] at baseline *v* 0 [0-0.5] at 3 months [p < 0.01] and 1.5 [0-3] at 12 months [p = 0.05]). The 12-month overall survival rate was 58%. Transient Horner syndrome occurred in 73% of patients; 1 patient had prolonged ptosis resolving within 2 weeks without sequelae. No hospitalizations for arrhythmic storm occurred during follow-up; 27% of patients underwent heart transplantation. The overall mortality rate was 33%, with all deaths attributable to cardiovascular disease progression. Conclusions BCSD is safe and effective for controlling arrhythmic events in refractory arrhythmic storm, significantly reducing ventricular arrhythmias during the first 6 months after the procedure and providing temporary stabilization for nearly 12 months with few adverse effects. Furthermore, it is associated with a 58% 12-month overall survival rate.
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González et al. (2026) conducted a cohort in Refractory arrhythmic storm (n=18). Ultrasound-guided percutaneous stellate ganglion block and bilateral cardiac sympathetic denervation vs. Baseline (pre-procedure) was evaluated on Change in sustained ventricular arrhythmias over a period of 12 months (p=<0.01 at 3 months; 0.05 at 12 months). Ultrasound-guided percutaneous SGB and BCSD reduced sustained ventricular arrhythmias from a median of 4 at baseline to 0 at 3 months (p<0.01) and 1.5 at 12 months (p=0.05).
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