Emerging Role of Percutaneous Left Stellate Ganglion Block for the Acute Management of Supraventricular Arrhythmias: A Single Center Experience

Background The efficacy of percutaneous left stellate ganglion block (PLSGB) for drug–refractory electrical storm is now well established. Instead, its beneficial effect on supraventricular arrhythmias (SVAs), supported by animal models, is still unexplored in humans. We’ve recently started to expand its usage to SVAs. Methods We hereby describe our single center experience of PLSGB for SVAs from 2/2021 to 12/2024. Results Among 88 patients treated with ultrasound guided PSGB, 14 (86% male, mean age 73 years) received a total of 15 PLSGBs for acute onset of SVAs. Specifically, 12 procedures were performed due to atrial fibrillation (AF), one for 2:1 atrial flutter, another for atrial tachycardia (AT) and the last one for supraventricular (SV) bigeminism. Most of the patients (79%) suffered ischemic cardiomyopathy (CMP), including 4 with an ongoing acute myocardial infarction; the rest had non ischemic CMP. The main SVAs trigger was acute decompensated heart failure (57% of patients), followed by acute coronary syndrome, Takotsubo syndrome and 1 case of post–operative coronary artery bypass surgery. PLSGB was performed for its negative dromotropic effect as well as its potential to favor cardioversion in patients with high risk of/ongoing hemodynamic instability. Most patients were on inotrops (10/14) and 2 also on intraortic balloon pump (2/14): SVAs had a mean ventricular rate of 138 ± 19 bpm despite ongoing medications (beta blockers, amiodarone). Most PLSGB (80%) were performed in the setting of impending or manifest cardiogenic shock (SCAI classification B or more), including 27% with sepsis. Mean LVEF was 30 ± 11%. Regarding AF patients, PLSGB resulted in spontaneous cardioversion into sinus rhythm within 1 hour (mostly within few minutes) in 58% of them (7/12); among the others (5/12) as well as the case of AT, PLSGB significantly reduced ventricular rate during AF/AT (mean 39% reduction) allowing for hemodynamic stabilitization. Additionally, PLSGB enabled complete suppression of SV premature complexes; in the single case of 2:1 atrial flutter, PLSGB had no effect. Overall, 12 hours–efficacy of PLSGB on rhythm/rate was 87%. There were no major complications. Conclusions Our preliminary data suggest that PLSGB usage, thanks to its easy feasibility and good safety profile, may be effective in the acute management of drug refractory SVAs either by facilitating cardioversion and/or by reducing ventricular response.