• Simone Savastano, Veronica Dusi, Enrico Baldi, Roberto Rordorf, Antonio Sanzo, Rita Camporotondo, Rosa Fracchia, Sara Compagnoni, Laura Frigerio, Oltrona ViscontiLuigiLDivision of Cardiology, Fondazione IRCCS Policlinico San Matteo, Via Golgi 19, 27100 Pavia, Italy., and Gaetano Maria De Ferrari.
• Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Via Golgi 19, 27100 Pavia, Italy.
• Europace. 2021 Apr 6; 23 (4): 581-586.

AimsThe adoption of percutaneous stellate ganglion blockade for the treatment of drug-refractory electrical storm (ES) has been increasingly reported; however, the time of onset of the anti-arrhythmic effects, the safety of a purely anatomical approach in conscious patients and the additional benefit of repeated procedures remain unclear.Methods And ResultsThis study included consecutive patients undergoing percutaneous left stellate ganglion blockade (PLSGB) in our centre for drug-refractory ES. Lidocaine, bupivacaine, or a combination of both were injected in the vicinity of the left stellate ganglion. Overall, 18 PLSGBs were performed in 11 patients (age 69 ± 13 years; 63.6% men, left ventricular ejection fraction 31.6 ± 16%). Seven patients received only one PLSGB; three underwent two procedures and one required three PLSGB and two continuous infusions to control ventricular arrhythmias (VAs). All PLSGBs were performed with an anatomical approach; lidocaine, alone, or in combination was used in 77.7% of the procedures. The median burden of VAs 1 h after each block was zero compared with five in the hour before (P < 0.001); 83% of the patients were free from VAs; the efficacy at 24 h increased with repeated blocks. The anti-arrhythmic efficacy of PLSGB was not related to anisocoria. No procedure-related complications were reported.ConclusionAnatomical-based PLSGB is a safe and rapidly effective treatment for refractory ES; repeated blocks provide additional benefits. Percutaneous left stellate ganglion blockade should be considered for stabilizing patients to allow further ES management.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.

18 keywords...

hide…