Background
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.
Objective
The purpose of this study was to assess the outcomes of SGB and the feasibility of
SG stimulation and recording in humans with VAs.
Methods
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: February 27, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: This work was supported by the Charles Burnett III and Lois and Carl Davis Centennial Chair endowments (MV) (Houston, TX).
Disclosures: The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2023 Heart Rhythm Society. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Directly investigating the role of stellate ganglion activity in patients with ventricular arrhythmiasHeart Rhythm
- PreviewSustained 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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