Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm

Ying Tian, Erica D. Wittwer, Suraj Kapa, Christopher J. McLeod, Peilin Xiao, Peter A. Noseworthy, Siva K. Mulpuru, Abhishek J. Deshmukh, Hon Chi Lee, Michael J. Ackerman, Samuel J. Asirvatham, Thomas M. Munger, Xing Peng Liu, Paul A. Friedman, Yong Mei Cha

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. METHODS: This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. RESULTS: Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications. CONCLUSIONS: SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.

Original languageEnglish (US)
Pages (from-to)e007118
JournalCirculation. Arrhythmia and electrophysiology
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2019

Fingerprint

Stellate Ganglion
Cardiac Arrhythmias
Implantable Defibrillators
Bupivacaine
Lidocaine
Hospital Mortality
Local Anesthetics
Cardiomyopathies
Pharmaceutical Preparations
Stroke Volume
Hospitalization
Neck
Mortality

Keywords

  • hospital mortality
  • hospitalization
  • stellate ganglion block
  • sympathetic nervous system
  • ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm. / Tian, Ying; Wittwer, Erica D.; Kapa, Suraj; McLeod, Christopher J.; Xiao, Peilin; Noseworthy, Peter A.; Mulpuru, Siva K.; Deshmukh, Abhishek J.; Lee, Hon Chi; Ackerman, Michael J.; Asirvatham, Samuel J.; Munger, Thomas M.; Liu, Xing Peng; Friedman, Paul A.; Cha, Yong Mei.

In: Circulation. Arrhythmia and electrophysiology, Vol. 12, No. 9, 01.09.2019, p. e007118.

Research output: Contribution to journalArticle

@article{c21563cb8fef4f628b92d32616e61049,
title = "Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm",
abstract = "BACKGROUND: Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. METHODS: This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. RESULTS: Clinical characteristics included age, 58±14 years; men, 73.3{\%}; and left ventricular ejection fraction, 34±16{\%}. At 24 hours, 60{\%} of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6{\%} versus 50.0{\%}; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92{\%} reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100{\%} versus 43.5{\%}; P=0.03) and recurrent VA within 24 hours (85.7{\%} versus 26.1{\%}; P=0.009). There were no procedure-related major complications. CONCLUSIONS: SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.",
keywords = "hospital mortality, hospitalization, stellate ganglion block, sympathetic nervous system, ventricular arrhythmia",
author = "Ying Tian and Wittwer, {Erica D.} and Suraj Kapa and McLeod, {Christopher J.} and Peilin Xiao and Noseworthy, {Peter A.} and Mulpuru, {Siva K.} and Deshmukh, {Abhishek J.} and Lee, {Hon Chi} and Ackerman, {Michael J.} and Asirvatham, {Samuel J.} and Munger, {Thomas M.} and Liu, {Xing Peng} and Friedman, {Paul A.} and Cha, {Yong Mei}",
year = "2019",
month = "9",
day = "1",
doi = "10.1161/CIRCEP.118.007118",
language = "English (US)",
volume = "12",
pages = "e007118",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm

AU - Tian, Ying

AU - Wittwer, Erica D.

AU - Kapa, Suraj

AU - McLeod, Christopher J.

AU - Xiao, Peilin

AU - Noseworthy, Peter A.

AU - Mulpuru, Siva K.

AU - Deshmukh, Abhishek J.

AU - Lee, Hon Chi

AU - Ackerman, Michael J.

AU - Asirvatham, Samuel J.

AU - Munger, Thomas M.

AU - Liu, Xing Peng

AU - Friedman, Paul A.

AU - Cha, Yong Mei

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. METHODS: This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. RESULTS: Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications. CONCLUSIONS: SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.

AB - BACKGROUND: Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. METHODS: This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. RESULTS: Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications. CONCLUSIONS: SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.

KW - hospital mortality

KW - hospitalization

KW - stellate ganglion block

KW - sympathetic nervous system

KW - ventricular arrhythmia

UR - http://www.scopus.com/inward/record.url?scp=85072143267&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072143267&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.118.007118

DO - 10.1161/CIRCEP.118.007118

M3 - Article

C2 - 31514529

AN - SCOPUS:85072143267

VL - 12

SP - e007118

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 9

ER -