Stellate Ganglion Blockade for the Treatment of Refractory Ventricular Arrhythmias

Fudim, Marat; Qadri, Yawar J.; Waldron, Nathan H.; Boortz-Marx, Richard L.; Garg, Arun; Patel, Chetan B.; Podgoreanu, Mihai V.; Sun, Albert Y.; Milano, Carmelo A.; Tong, Betty C.; Harpole, David H.; Mathew, Joseph P.; Piccini, Jonathan P.

doi:10.1016/j.jacep.2019.12.017

Cited by 61 publications

(36 citation statements)

References 19 publications

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“…Sympathetic denervation in the heart combined with the presence of high NE levels is tightly correlated to progression of HF and SCD[ 162 ]. From the other way around, stellate ganglion blockade was effective in the acute reduction of ventricular arrhythmia burden and suppression of electrical storm thus clinically validating the concept that attenuation of sympathetic outflow to the heart from sympathetic ganglia can indeed mitigate the risk of future arrhythmic events[ 163 - 165 ]. These clinical observations were inspired by the previous animal study demonstrating that spontaneous high-amplitude discharge activity from left stellate ganglion was strongly associated with the induction of malignant ventricular arrhythmias[ 166 ].…”

Section: Sympathetic Nervous System Pathophysiology and Adrenergic Dymentioning

confidence: 99%

Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers

Borovac

D’Amario

Božić

et al. 2020

WJC

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Heart failure (HF) is a complex clinical syndrome characterized by the activation of at least several neurohumoral pathways that have a common role in maintaining cardiac output and adequate perfusion pressure of target organs and tissues. The sympathetic nervous system (SNS) is upregulated in HF as evident in dysfunctional baroreceptor and chemoreceptor reflexes, circulating and neuronal catecholamine spillover, attenuated parasympathetic response, and augmented sympathetic outflow to the heart, kidneys and skeletal muscles. When these sympathoexcitatory effects on the cardiovascular system are sustained chronically they initiate the vicious circle of HF progression and become associated with cardiomyocyte apoptosis, maladaptive ventricular and vascular remodeling, arrhythmogenesis, and poor prognosis in patients with HF. These detrimental effects of SNS activity on outcomes in HF warrant adequate diagnostic and treatment modalities. Therefore, this review summarizes basic physiological concepts about the interaction of SNS with the cardiovascular system and highlights key pathophysiological mechanisms of SNS derangement in HF. Finally, special emphasis in this review is placed on the integrative and up-to-date overview of diagnostic modalities such as SNS imaging methods and novel laboratory biomarkers that could aid in the assessment of the degree of SNS activation and provide reliable prognostic information among patients with HF.

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Section: Sympathetic Nervous System Pathophysiology and Adrenergic Dymentioning

confidence: 99%

Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers

Borovac

D’Amario

Božić

et al. 2020

WJC

View full text Add to dashboard Cite

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“…However, it should be noted that the risk of phrenic nerve paralysis is higher in bilateral SGB, and care should be taken when this is performed in the unintubated patient. Indeed, the risk of palsy to surrounding nervous structures is highlighted in a recent retrospective analysis of 20 patients, where the only complication was 1 case of hoarseness, which was attributed to inadvertent recurrent laryngeal nerve palsy ( 11 ). This is mirrored in our case, where left-sided vocal fold paralysis resulted in inspiratory stridor and urgent orotracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

Autonomic Modulation for Treatment of Repolarization Alternans and Refractory Ventricular Electrical Storm

et al. 2021

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Macroscopic T-wave alternans (TWA) is a rare finding on surface electrocardiogram and has been associated with an increased risk of impending sudden cardiac death. We highlight a case of macroscopic TWA in a patient with markedly prolonged QTc interval preceding ventricular electrical storm, which was refractory to medical management. Autonomic modulation of the stellate ganglion resulted in improvement in both TWA and QTc interval. ( Level of Difficulty: Advanced. )

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“…Furthermore, the bilateral SGB procedure acutely reduces monomorphic and polymorphic VT and is recommended to be performed under ultrasound guidance [7]. When SGB is performed for VES treatment, the VES burden can be seen to decrease after 2 doses, and cases of complete remission after 3-4 or so trials have been reported.…”

Section: Case Reportmentioning

confidence: 99%

Effect of Stellate Ganglion Block in Patients with Ventricular Electrical Storm: A Case Report

Kwon

Kim

Lee

et al. 2022

Soonchunhyang Med Sci

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If cardiac sympathetic activity increases after myocardial injury, a ventricular electrical storm (VES) may occur. The stellate ganglion block is a minimally invasive technique performed to control VES through temporary sympathetic cessation. This case was treated after 3 stellate ganglion blocks in VES developed after non-ST elevation myocardial infarction. This patient underwent prophylactic stellate ganglion block prior to radical nephrectomy for a renal mass found during hospitalization, and the operation was safely completed. Stellate ganglion block is expected to be a safe treatment option for patients with unstable VES.

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Stellate Ganglion Blockade for the Treatment of Refractory Ventricular Arrhythmias

Cited by 61 publications

References 19 publications

Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers

Sympathetic nervous system activation and heart failure: Current state of evidence and the pathophysiology in the light of novel biomarkers

Autonomic Modulation for Treatment of Repolarization Alternans and Refractory Ventricular Electrical Storm

Effect of Stellate Ganglion Block in Patients with Ventricular Electrical Storm: A Case Report

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