Percutaneous Stellate Ganglion Block in Electrical Storm: A Scoping Review

Electrical storm (ES) is characterized by recurrent ventricular dysrhythmias (RVDs) requiring emergent intervention, and associated with poor outcomes. They are classically refractory to conventional treatments like antidysrhythmics and defibrillation, mandating sympathetic blockade. Stellate ganglion block (SGB) is gaining prominence as a feasible bedside intervention, serving as a bridge to definitive management.

This scoping review evaluates the effectiveness and safety of percutaneous SGB in managing ES.

A systematic search was conducted across PubMed, Google Scholar, Embase, and DOAJ for studies from 2001 to 2024 that examined SGB's role in treating ES. Inclusion criteria were studies involving human subjects, reporting clinical outcomes. Two independent reviewers screened titles and abstracts, followed by full-text evaluations. Data on demographics, procedural characteristics, and outcomes were extracted and analyzed. A total of 74 full-text articles were included, comprising 43 case reports, 15 case series, 13 cohort studies, and 4 systematic reviews.

The most common trigger for ES was acute coronary syndrome. SGB was performed predominantly using ultrasound guidance. Bupivacaine and lidocaine were the most commonly used anesthetics. SGB effectively reduced VD episodes in 59-80% of cases, with dysrhythmia control lasting hours to several months. SGB seemed to improve short-term survival, without affecting long-term outcomes. Minor transient complications like hoarseness of voice were noted, but major complications were rare.

Percutaneous SGB appears promising for managing refractory ES, demonstrating efficacy in dysrhythmia control and a favorable safety profile. Further research, including observational studies and randomized controlled trials to study the efficacy and safety of the procedure, is essential to establish treatment protocols and investigate long-term benefits.