Electrical storm treatment by percutaneous stellate ganglion block: the STAR study

Abstract

Background and Aims An electrical storm (ES) is a clinical emergency with a paucity of established treatment options. Despite initial encouraging reports about the safety and effectiveness of percutaneous stellate ganglion block (PSGB), many questions remained unsettled and evidence from a prospective multicentre study was still lacking. For these purposes, the STAR study was designed. Methods This is a multicentre observational study enrolling patients suffering from an ES refractory to standard treatment from 1 July 2017 to 30 June 2023. The primary outcome was the reduction of treated arrhythmic events by at least 50% comparing the 12 h following PSGB with the 12 h before the procedure. STAR operators were specifically trained to both the anterior anatomical and the lateral ultrasound-guided approach. Results A total of 131 patients from 19 centres were enrolled and underwent 184 PSGBs. Patients were mainly male (83.2%) with a median age of 68 (63.8–69.2) years and a depressed left ventricular ejection fraction (25.0 ± 12.3%). The primary outcome was reached in 92% of patients, and the median reduction of arrhythmic episodes between 12 h before and after PSGB was 100% (interquartile range −100% to −92.3%). Arrhythmic episodes requiring treatment were significantly reduced comparing 12 h before the first PSGB with 12 h after the last procedure [six (3–15.8) vs. 0 (0–1), P < .0001] and comparing 1 h before with 1 h after each procedure [2 (0–6) vs. 0 (0–0), P < .001]. One major complication occurred (0.5%). Conclusions The findings of this large, prospective, multicentre study provide evidence in favour of the effectiveness and safety of PSGB for the treatment of refractory ES.

The Intrinsic Cardiac Nervous System: From Pathophysiology to Therapeutic Implications

“…As already mentioned, sympato-vagal balance is of pivotal importance for ventricular electrical stability, both in structurally normal hearts [26,126] as well as in cardiac pathology [127,128], independently from the etiology. As a general concept, at the ventricular level, sympathetic activation is pro-arrhythmic while the parasympathetic one is antiarrhythmic, with extremely rare exceptions.…”

Editorial: The wide spectrum of ventricular arrhythmias: from out-of-hospital cardiac arrest to advanced in-hospital treatment

“…Also with regard to ICD patients, Regoli et al carried out a review on the management of hemodynamically stable, incessant wide QRS complex tachycardia in patients who already received an ICD, which represents a challenging situation. The authors proposed an approach based on four different phases to deal with these patients: hemodynamic status assessment; preparation for therapy and removal of potential triggers; therapy administration including anti-arrhythmic drugs, device reprogramming and acute neuromodulation, which is promising in treating this type of patients (6); hospitalization and prevention of arrhythmic relapses.…”