Stellate Ganglion Blockade With Continuous Infusion Versus Single Injection for Treatment of Ventricular Arrhythmia Storm

Saket Sanghai, Nicholas J. Abbott, Thomas A. Dewland, Charles A. Henrikson, Miriam R. Elman, Michael Wollenberg, Ryan Ivie, Julio Gonzalez-Sotomayor, Babak Nazer

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objectives: This study sought to compare the efficacy and safety of single-injection stellate ganglion block (SGB) with a novel continuous-infusion SGB procedure. Background: SGB for ventricular arrhythmia (VA) storm is typically performed with a single injection of local anesthetic agents. Methods: Eighteen patients underwent left-sided SGB (9 single injection and 9 continuous infusion). The number of implantable cardioverter-defibrillator therapies and sustained VAs/24 h were compared between the pre-SGB and post-SGB periods. Adverse effects of SGB and in-hospital outcomes were also compared. Results: The mean age was 61.1 ± 13.7 years. The presenting arrhythmia was ventricular tachycardia in 13 (72%) patients, ventricular fibrillation in 4 (22%), and both in 1 (6%). Single-injection SGB reduced VA/24 h by a median of 0.3 (interquartile range: 0.2 to 0.9), which was a 45% reduction (p = 0.008), resulting in 5 of 9 patients with no recurrent VA. Continuous-infusion SGB reduced VA/24 h by a median of 2.0 (interquartile range: 1.3 to 3.0), which was a 94% reduction (p = 0.004), resulting in 7 of 9 patients with no recurrent VA (p = 0.006 for comparison with single injection). Transient left arm weakness and voice hoarseness were each noted in 1 patient in both groups. Repeat SGB was required in 4 (44%) patients in the single-injection group. In-hospital outcomes were similar between the groups. Conclusions: In patients with VA storm, SGB performed via both continuous-infusion and single-injection approaches provided significant reductions in VA burden. Compared to single-injection SGB, continuous-infusion was associated with a greater reduction in VA burden and similar adverse events, without the need for repeat procedures.

Original languageEnglish (US)
Pages (from-to)452-460
Number of pages9
JournalJACC: Clinical Electrophysiology
Volume7
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • autonomic modulation
  • stellate ganglion block
  • sympathetic nervous system
  • ventricular fibrillation
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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