CT-guided Left Stellate Ganglion Cryoneurolysis for Refractory Ventricular Arrhythmias

Background Ventricular arrhythmias (VAs), including ventricular tachycardia and ventricular fibrillation, present substantial therapeutic challenges due to their high morbidity, mortality, and increasing prevalence. Current treatments often prove infeasible or inadequate in patients with refractory VAs. Purpose To evaluate the safety and effectiveness of CT-guided left stellate ganglion cryoneurolysis (SGC) in the treatment of refractory VAs. Materials and Methods This retrospective study reviewed all consecutive patients with refractory VAs who underwent SGC between June 2020 and December 2023 at two tertiary care centers. Patients with refractory VAs who underwent CT-guided left SGC were included. No patients were excluded. Data on preprocedural clinical status, procedural approach, procedural outcomes, and adverse events were analyzed. The pre- and postprocedural number of defibrillations were compared using the Wilcoxon matched-pairs signed rank test. Results A total of 17 patients (mean age, 60.4 years ± 2.7 [standard error of the mean]; 14 male) were included; seven patients (41%) were receiving β-adrenergic blocking agents. The mean number of antiarrhythmic medications per patient was 2.2 ± 0.2. CT-guided left SGC led to a significant reduction in defibrillations, from a median of 3 (IQR, 3-15) to 0 (IRQ, 0-0) in the 24 hours before and after the procedure, respectively (P < .001). Clinical success, defined as freedom from defibrillation within the preceding 24-hour period, was achieved in 14 of 17 patients (82%) 24 hours after and 15 of 17 patients (88%) 72 hours after the procedure. Of 17 patients, 12 (71%) proceeded to additional procedural management after SGC. At a mean follow-up of 469.2 days ± 90.8, 14 of 17 patients (82%) were alive. No moderate or high-grade adverse events were observed; mild adverse events included left upper extremity neurapraxia (n = 1) and transient Horner syndrome (n = 3). Conclusion CT-guided left SGC demonstrated promising effectiveness and safety in treating patients with refractory VAs. Thus, SGC warrants consideration for inclusion in a multidisciplinary treatment algorithm for VAs. © RSNA, 2024 See also the editorial by Cadour and Scemama in this issue.