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Lazzari L, Donzelli S, Tordini A, Parise A, Pirozzi C, Di Meo F, Marallo C, Pace V, Marini C, Carreras G. The point on the treatment of arrhythmic storm. Eur Heart J Suppl 2024; 26:i44-i48. [PMID: 38867867 PMCID: PMC11167961 DOI: 10.1093/eurheartjsupp/suae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Arrhythmic storm is a clinical emergency associated with high mortality, which requires multi-disciplinary management. Reprogramming of the implantable cardiac defibrillator (ICD) aimed at reducing shocks, adrenergic blockade using beta-blockers, sedation/anxiolysis, and blockade of the stellate ganglion represent the first simple and effective manoeuvres, but further suppression of arrhythmias with antiarrhythmics is often required. A low-risk patient (e.g. monomorphic ventricular tachycardia, functioning ICD, and haemodynamically stable) should be managed with a beta-blocker (possibly non-selective) plus amiodarone, in addition to sedation with a benzodiazepine or dexmedetomidine; in patients at greater risk (high burden and haemodynamic instability), autonomic modulation with blockade of the stellate ganglion and the addition of a second antiarrhythmic (lidocaine) should be considered. In patients refractory to these measures, with advanced heart failure, general anaesthesia with intubation and the establishment of a haemodynamic circulatory support should be considered. Ablation, performed early, appears to be superior in terms of mortality and reduction of future shocks compared with titration of antiarrhythmics.
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Affiliation(s)
- Ludovico Lazzari
- SSD of Clinical and Interventional Arrhythmology, ‘S. Maria’, Terni
| | - Stefano Donzelli
- SSD of Clinical and Interventional Arrhythmology, ‘S. Maria’, Terni
| | | | - Antonio Parise
- SSD of Clinical and Interventional Arrhythmology, ‘S. Maria’, Terni
- Cardiology, University of Perugia
| | | | - Federica Di Meo
- SSD of Clinical and Interventional Arrhythmology, ‘S. Maria’, Terni
- SC of Cardiology, ‘S. Maria’, Terni
| | | | - Vincenzo Pace
- SSD of Clinical and Interventional Arrhythmology, ‘S. Maria’, Terni
- Cardiology, University of Perugia
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Ryu H, Kim H. The usefulness of stellate ganglion block with ultrasound-guided lateral paracarotid approach in ventricular arrhythmias: A case series. Saudi J Anaesth 2024; 18:276-279. [PMID: 38654862 PMCID: PMC11033875 DOI: 10.4103/sja.sja_657_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 04/26/2024] Open
Abstract
Ventricular arrhythmias are life-threatening cardiac events. Sympathetic nervous system blockade represents a crucial therapeutic method for refractory ventricular arrhythmias. Ultrasound (US) imaging for stellate ganglion block (SGB) suggests potential for its application to safer and more accurate methods. We had thirteen patients diagnosed with refractory ventricular arrhythmia and referred to the pain clinic for SGB. We visited the intensive care unit (ICU) and performed SGB with the lateral paracarotid approach technique in the ICU. Using a new approach, we easily performed SGB and felt the convenience of the procedure in the ICU. In eleven cases, we also confirmed that the effect of the block with the new technique was satisfactory. SGB, with the new technique, revealed efficiency in the recovery process of the patients. We recommended the lateral paracarotid approach technique for SGB when a patient in an ICU showed ventricular arrhythmias and should be treated with SGB.
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Affiliation(s)
- Hansung Ryu
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hyuckgoo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Uhm JS, Oh SK, Park JW, Joung B, Pak HN, Lee MH. Recurrent ventricular fibrillation treated with scar homogenization in a patient with arrhythmogenic cardiomyopathy. HeartRhythm Case Rep 2024; 10:250-254. [PMID: 38766616 PMCID: PMC11096426 DOI: 10.1016/j.hrcr.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Su Kyung Oh
- Biosense Webster, Johnson & Johnson, Inc, Seoul, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Savastano S, Baldi E, Compagnoni S, Rordorf R, Sanzo A, Gentile FR, Dusi V, Frea S, Gravinese C, Cauti FM, Iannopollo G, De Sensi F, Gandolfi E, Frigerio L, Crea P, Zagari D, Casula M, Sangiorgi G, Persampieri S, Dell’Era G, Patti G, Colombo C, Mugnai G, Notaristefano F, Barengo A, Falcetti R, Perego GB, D’Angelo G, Tanese N, Currao A, Sgromo V, De Ferrari GM. Electrical storm treatment by percutaneous stellate ganglion block: the STAR study. Eur Heart J 2024; 45:823-833. [PMID: 38289867 PMCID: PMC10919918 DOI: 10.1093/eurheartj/ehae021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/27/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND AND AIMS An electrical storm (ES) is a clinical emergency with a paucity of established treatment options. Despite initial encouraging reports about the safety and effectiveness of percutaneous stellate ganglion block (PSGB), many questions remained unsettled and evidence from a prospective multicentre study was still lacking. For these purposes, the STAR study was designed. METHODS This is a multicentre observational study enrolling patients suffering from an ES refractory to standard treatment from 1 July 2017 to 30 June 2023. The primary outcome was the reduction of treated arrhythmic events by at least 50% comparing the 12 h following PSGB with the 12 h before the procedure. STAR operators were specifically trained to both the anterior anatomical and the lateral ultrasound-guided approach. RESULTS A total of 131 patients from 19 centres were enrolled and underwent 184 PSGBs. Patients were mainly male (83.2%) with a median age of 68 (63.8-69.2) years and a depressed left ventricular ejection fraction (25.0 ± 12.3%). The primary outcome was reached in 92% of patients, and the median reduction of arrhythmic episodes between 12 h before and after PSGB was 100% (interquartile range -100% to -92.3%). Arrhythmic episodes requiring treatment were significantly reduced comparing 12 h before the first PSGB with 12 h after the last procedure [six (3-15.8) vs. 0 (0-1), P < .0001] and comparing 1 h before with 1 h after each procedure [2 (0-6) vs. 0 (0-0), P < .001]. One major complication occurred (0.5%). CONCLUSIONS The findings of this large, prospective, multicentre study provide evidence in favour of the effectiveness and safety of PSGB for the treatment of refractory ES.
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Affiliation(s)
- Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Roberto Rordorf
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Antonio Sanzo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Veronica Dusi
- Division of Cardiology, Molinette Hospital, Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Simone Frea
- Division of Cardiology, Molinette Hospital, Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Carol Gravinese
- Division of Cardiology, Molinette Hospital, Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | | | | | | | - Edoardo Gandolfi
- Division of Cardiology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Laura Frigerio
- Division of Cardiology, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
- Division of Cardiology, Maggiore Hospital, Crema, Italy
| | - Pasquale Crea
- Division of Cardiology, G. Martino Hospital, Messina, Italy
| | - Domenico Zagari
- Division of Cardiology, Humanitas Mater Domini, Castellanza, Italy
| | - Matteo Casula
- Division of Cardiology, ‘San Michele’ dell’ARNAS G. Brotzu Hospital, Cagliari, Italy
| | | | | | - Gabriele Dell’Era
- Division of Cardiology, Maggiore della carità Hospital, Novara, Italy
| | - Giuseppe Patti
- Division of Cardiology, Maggiore della carità Hospital, Novara, Italy
- University of Eastern Piedmont ‘Amedeo Avogadro’, Novara, Italy
| | - Claudia Colombo
- Division of Cardiology, ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giacomo Mugnai
- Division of Cardiology, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | | | - Alberto Barengo
- Division of Cardiology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Roberta Falcetti
- Division of Cardiology, Sant’Andrea University Hospital, Rome, Italy
| | | | - Giuseppe D’Angelo
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Nikita Tanese
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
| | - Vito Sgromo
- AREU Azienda Regionale Emergenza Urgenza, AAT Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Molinette Hospital, Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
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De Giorgi F, Scaramuzzo G, Bertini M, Malagù M. A modified approach to percutaneous ultrasound-guided left stellate ganglion block for drug-refractory electrical storm: a case report. Eur Heart J Case Rep 2024; 8:ytae101. [PMID: 38476286 PMCID: PMC10928486 DOI: 10.1093/ehjcr/ytae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/27/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
Background The use of percutaneous stellate ganglion block (SGB) in the management of drug-refractory electrical storm (ES) has been increasingly reported in the last years. Few data are available on the safety, duration, and dosage of local anaesthetic used. Case summary A 66-year-old male patient with a history of ischaemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD) presented to the emergency room complaining several ventricular arrhythmias and ICD shocks received in the last 24 h. He was treated with many lines of anti-arrhythmic drugs but his condition deteriorated with cardiovascular instability and respiratory distress, so he was intubated. The ES still worsened (82 episodes of ventricular arrhythmias), so we performed an ultrasound-guided left SGB, using a modified technique, with success in suppressing the ventricular arrhythmias. The patient was then treated with electrophysiological study and catheter ablation. Discussion The ultrasound approach to SGB is feasible in emergency setting, and it is safe and effective also using a modified and easier technique in patient with difficult sonographic visualization of the neck structures. Moreover, it is possible and safe to use a combination of short-acting rapid-onset local anaesthetic with a long-lasting one with a good outcome.
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Affiliation(s)
- Francesco De Giorgi
- Anesthesia and Intensive Care Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gaetano Scaramuzzo
- Anesthesia and Intensive Care Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8, Ferrara 44124, Italy
| | - Michele Malagù
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8, Ferrara 44124, Italy
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