Low-Intensity Focused Ultrasound Modulation of Stellate Ganglion Attenuates Post-STEMI Ventricular Arrhythmias

Sympathetic overactivation contributes to ventricular arrhythmias (VAs) after ST-segment elevation myocardial infarction (STEMI). Preclinical study demonstrated that low-intensity focused ultrasound (LIFU) modulation of the left stellate ganglion (LSG) reduced post-STEMI VAs. This study aimed to investigate whether LIFU modulation of LSG reduces VAs following primary percutaneous coronary intervention (PCI) in patients with STEMI. In this single-center, prospective, randomized, sham-controlled exploratory study, 41 STEMI undergoing primary PCI were assigned to LIFU modulation (n = 20) or sham stimulation (n = 21). LIFU was initiated in the catheterization laboratory and continued in the ward. All patients were followed up for 7 days and underwent Holter monitoring, serum biomarker assessment, echocardiographic evaluation, and safety assessment. LIFU significantly reduced VA burden within 72 hours after PCI. Heart rate variability analysis indicated reduced low-frequency power and a decreased low-frequency/high-frequency ratio. Exploratory analyses also showed lower levels of proinflammatory cytokines and sympathetic neurotransmitters. Myocardial injury markers did not differ significantly between groups, whereas left ventricular ejection fraction was higher in the LIFU group on day 7. Furthermore, no significant organ dysfunction or thermal injury was observed following LIFU intervention. LIFU modulation of LSG might attenuate sympathetic activity and reduce VAs in patients with STEMI undergoing PCI. This study provides the first clinical evidence supporting LIFU as a promising noninvasive neuromodulatory strategy for VA prevention in the STEMI setting. Larger multicenter trials (NCT07587294/ChiCTR2600122798, ongoing) are warranted to confirm these findings. This study offers a novel strategy for the management of VAs following STEMI.