Stellate ganglion ablation by conventional radiofrequency in patients with electrical storm

Abstract

Aims We report a series of patients with Electrical Storm (ES) who underwent bilateral stellate ganglion ablation by using conventional radio frequency (RFA). Methods and results The procedure was done with fluoroscopic guidance using the COSMAN™ 1A RF Generator and a 22G RF needle (5 cm length and 5 mm active tip). Six patients, four male and two female (mean age 55 ± 7 years and mean LVEF—42 ± 21%) with ES underwent the procedure under fluoroscopic guidance. All patients experienced recurrent ICD shocks or required multiple external defibrillation shocks. There were no procedural complications. All patients survived free of ES at discharge. At a mean follow—up of 22 ± 8months, all were alive free of ES but two patients received appropriate shocks for VT and one patient had VT terminated by ATP. Conclusion This small series of cases is a proof of concept that neuromodulation by conventional RFA targeting bilateral stellate ganglia appears safe, feasible, and effective in treating selected unstable patients with ES.

Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC—endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society

“… 209 Of note, efficacy of cryoenergy-induced and radiofrequency-induced SGBs have been reported in small case series. 210 , 211 In a recent RCT in 26 patients with refractory ES, transcutaneous magnetic stimulation (a new, non-invasive method of modulating a patient’s nervous system activity) that targeted the left stellate ganglion was no better than a sham procedure in preventing VT recurrence within 24 h but was more effective in reducing VT burden (incidence rate ratio, 0.42; P < 0.001) and number of AADs. 212 …”