Research Article|Articles in Press

Stellate ganglion instrumentation for pharmacological blockade, nerve recording, and stimulation in patients with ventricular arrhythmias: Preliminary experience

Published:February 27, 2023DOI:


      Stellate ganglion blockade (SGB) can control ventricular arrhythmias (VAs), but outcomes are unclear. Percutaneous stellate ganglion (SG) recording and stimulation in humans has not been reported.


      The purpose of this study was to assess the outcomes of SGB and the feasibility of SG stimulation and recording in humans with VAs.


      Two patient cohorts were included—group 1: patients undergoing SGB for drug-refractory VAs. SGB was performed by injection of liposomal bupivacaine. Incidence of VAs at 24 and 72 hours and clinical outcomes were collected; group 2: patients undergoing SG stimulation and recording during VA ablation; a 2-F octapolar catheter was placed at the SG at the C7 level. Recording (30 kHz sampling, 0.5–2 kHz filter) and stimulation (up to 80 mA output, 50 Hz, 2 ms pulse width for 20–30 seconds) was performed.


      Group 1 included 25 patients [age 59.2 ± 12.8 years; 19 (76%) men] who underwent SGB for VAs. Nineteen patients (76.0%) were free of VA up to 72 hours postprocedure. However, 15 (60.0%) had VAs recurrence for a mean of 5.47 ± 4.52 days. Group 2 included 11 patients (mean age 63 ± 12.7 years; 82.7% men). SG stimulation caused consistent increases in systolic blood pressure. We recorded unequivocal signals with temporal association with arrhythmias in 4 of 11 patients.


      SGB provides short-term VA control, but has no benefit in the absence of definitive VA therapies. SG recording and stimulation is feasible and may have value to elicit VA and understand neural mechanisms of VA in the electrophysiology laboratory.


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      Linked Article

      • Directly investigating the role of stellate ganglion activity in patients with ventricular arrhythmias
        Heart Rhythm
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          Sustained ventricular arrhythmias (VAs) are a leading cause of morbidity and mortality worldwide.1 The autonomic nervous system has been recognized as an important modulator of sustained VAs and electrical storm (defined as ≥3 sustained VAs within a 24-hour period).1,2 Percutaneous stellate ganglion (SG) blockade has emerged as an alternative and effective modality for managing patients with hemodynamically unstable refractory VAs or electrical storm.2–4 To date, literature on the efficacy and safety profile of SG blockade has been limited to case reports and small cohort studies.
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