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Ultrasound-guided stellate ganglion block in patients with electrical storm: A single-center case series
Jun Zhang1, Jingwen Liang1, Tieshuai Liu1
1Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
Study Objective:
Increasing evidence suggests that stellate ganglion block (SGB) for the treatment of electrical storm (ES) shows encouraging effectiveness. This study aimed to evaluate the effects of SGB in patients with ES.
Design:
A single-center case series.
Setting:
Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.
Patients:
ES Patients with SGB treated between July 2023 and July 2024.
Interventions:
Patients with ES received SGB.
Measurements:
The primary outcomes included changes in sustained ventricular arrhythmias and anti-tachycardia pacing (ATP) or defibrillation shocks within 24 h before and after SGB. Effectiveness was defined as a ≥ 50 % reduction in these events post-block.
Main Results:
Between July 2023 and July 2024, 20 patients with ES underwent SGB. Among them, 60 % had persistent ES following catheter ablation, 20 % were diagnosed upon emergency admission, and 15 % developed ES after cardiac surgery. Within 24 h of the first SGB, the median (interquartile range, IQR) number of sustained ventricular arrhythmias decreased from 4.5 (3.0-13.0) to 0 (0-1.0), (median difference = -5.5, 95 % confidence interval [CI] = -9.5 to -3.0, p = 0.001), with an effectiveness rate of 80.0 %. Similarly, ATP or shocks decreased from 1.5 (0-4.0) to 0 (0-0.75), (median difference = -2.0, 95 % CI = -4.5 to -0.5, p = 0.011), indicating an effectiveness rate of 78.6 %. Compared to baseline levels, within 24 h after the last SGB, the median (IQR) number of sustained ventricular arrhythmias significantly decreased from 4.5 (3.0-13.0) to 0 (0-0.75), (median difference = -5.0, 95 % CI = -10.5 to -2.5, p = 0.004), achieving an effectiveness rate of 80.0 %. Likewise, ATP or shock events declined from 1.5 (0-4.0) to 0 (0-0), (median difference = -1.75, 95 % CI = -12.5 to -0.5, p = 0.028), reflecting an effectiveness rate of 86.7 %. In this study, 10 % of patients experienced minor complications after SGB, including one case of hoarseness and another case of phrenic nerve block. Both fully recovered without sequelae.
Conclusions:
SGB appears to be a safe and effective treatment that may provide temporary stabilization between the onset of ES and catheter ablation, while also aiding in the management of persistent ES post-catheter ablation and newly developed ES following cardiac surgery.
