Abstract 4357104: Relevance Of Stellate Ganglion Blockade In Patients With Refractory Ventricular Arrhythmias- A Systematic Review

Abstract

BACKGROUND: Life-threatening cardiac arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF) may persist despite treatment. Given the significant morbidity and mortality associated with these resistant arrhythmias, the development of alternative therapeutic strategies is imperative. Recently, the Stellate Ganglion Blockade (SGB), a neuro-modulatory treatment which targets sympathetic cardiac innervation, has gained popularity as a potential treatment option. This review evaluates recent evidence on the therapeutic efficacy and safety of ultrasound-guided (USG) SGB in treating patients with drug-refractory VT/VF. METHODS: A thorough literature review covering research published between 2006 and 2024 was undertaken. The inclusion criteria focused on adult patients receiving USG-guided SGB for refractory VT/VF. A total of seven studies were reviewed. The primary outcomes assessed included arrhythmia recurrence and adverse effects following SGB. Statistical analysis was performed using the Student’s t-test. RESULTS: In a pooled cohort of 377 patients with drug-refractory VT/VF, SGB was associated with a statistically significant reduction in arrhythmia burden. Within the first 24 hours of USG SGB with long-acting local anesthetics (ropivacaine, lidocaine, or bupivacaine 0.25–0.5%), VT/VF episodes markedly decreased. The median number of events dropped from 4.5 to 0 (p < 0.001). In other analyses, the median arrhythmic burden dropped by more than 60%, and up to 74.6% of patients remained arrhythmia-free 48 hours post-intervention. Up to 92% of patients had no VF by 72 hours, and as many as 72% showed total suppression of arrhythmias within the first 24 hours. In cases of electrical storm, over half of the patients who received SGB experienced full arrhythmic resolution in less than 12 hours. Transient Horner's syndrome was the most common adverse event, occurring in about 86% of patients. No long-term neurological impairments, hemodynamic compromise, or procedural complications were reported. CONCLUSION: For severely sick patients with refractory VT/VF, SGB appears to be a valuable adjunctive therapy that can rapidly and permanently control potentially lethal arrhythmias. Transitory Horner's syndrome is the most common adverse effect. Despite encouraging results, small-scale, non-randomized research provides the majority of the data currently available. Larger, multicenter RCTs are required to verify efficacy and evaluate long-term outcomes.