Stellate ganglion blockade for the treatment of refractory ventricular arrhythmias: A systematic review and meta-analysis.

Published

Journal Article (Review)

Treatment refractory ventricular arrhythmias (VAs) are often driven and exacerbated by heightened sympathetic tone. We aim to conduct a systematic review and meta-analysis of published studies of a temporary percutaneous stellate ganglion block (SGB) on VA burden and defibrillation episodes in patients with treatment refractory VAs.Relevant studies from January 1960 through May 2017 were identified in PubMed and Google Scholar. We performed a patient-level analysis using Student's t-test to compare outcomes before and after SGB.We identified 22 unique case series with a total of 35 patients. Patients were 57 ± 17 years old and 69% were males with a high burden of VA. A unilateral (left)-sided SGB was used in 85.7% (30 of 35) of cases and the remaining were bilateral SGB. The use of a unilateral or bilateral SGB resulted in a significant reduction of VA episodes (24-hours pre: mean 16.5 [CI 9.7-23.1] events vs. post: mean 1.4 [CI 0.85-2.01] events; P = 0.0002) and need for defibrillation (24-hours pre: mean 14.2 [CI 6.8-21.6] vs. post: mean 0.6 [CI 0.3-0.9]; P = 0.0026). Furthermore, SGB was significantly associated with a reduction of VA burden regardless of etiology of cardiomyopathy, type of ventricular rhythm, and degree of contractile dysfunction. SGB was followed by surgical sympathectomy in 21% of cases.Early experience suggests that SGB is associated with an acute reduction in the VA burden and offers potential promise for a broader use in high-risk populations. Randomized controlled studies are needed to confirm the safety and efficacy of this therapy.

Full Text

Duke Authors

Cited Authors

  • Fudim, M; Boortz-Marx, R; Ganesh, A; Waldron, NH; Qadri, YJ; Patel, CB; Milano, CA; Sun, AY; Mathew, JP; Piccini, JP

Published Date

  • December 2017

Published In

Volume / Issue

  • 28 / 12

Start / End Page

  • 1460 - 1467

PubMed ID

  • 28833780

Pubmed Central ID

  • 28833780

Electronic International Standard Serial Number (EISSN)

  • 1540-8167

International Standard Serial Number (ISSN)

  • 1045-3873

Digital Object Identifier (DOI)

  • 10.1111/jce.13324

Language

  • eng