Left stellate ganglion block, a rescue treatment for ventricular arrhythmia refractory to radiofrequency catheter ablation: A care-compliant case report

Ultrasound-Guided Stellate Ganglion Radiofrequency in a Patient with Ventricular Tachycardia Sensitive to Implantable Cardioverter Defibrillator: A Case Report

Introduction

Electrical storms and ventricular tachycardia are two life-threatening arrhythmias that are becoming more common. In developing ventricular arrhythmias, the sympathetic nervous system plays a vital role. Stellate ganglion (SG) block can be used in many situations as an important therapeutic target, like treating tachyarryhthmias and ventricular tachyarrhythmias.

Case Presentation

The patient was a 53 years old woman with a history of implantable cardioverter defibrillator (ICD) insertion due to ventricular tachycardia. The patient complained of an awkward and unpleasant sensation when the ICD sensed the tachyarrhythmia and shocked her. Regarding the positive response to the previous SG block, with the goal of a longer duration of this effect, stellate ganglion radiofrequency was performed.

Conclusions

Stellate ganglion radiofrequency shows a safe and long-term effect for patients with tachyarrhythmias and ICD who cannot tolerate episodes of ICD activation.

Effects of Ultrasound-Guided Stellate Ganglion Block on Postoperative Quality of Recovery in Patients Undergoing Breast Cancer Surgery: A Randomized Controlled Clinical Trial

Surgery has been the primary treatment for breast cancer. However, instant postoperative complications, such as sleep disorder and pain, dramatically impair early postoperative quality of recovery, resulting in more extended hospital stays and higher costs. Recent clinical trials indicated that stellate ganglion block (SGB) could prolong sleep time and improve sleep quality in breast cancer survivors. Moreover, during the perioperative period, SGB enhanced the recovery of gastrointestinal functions in patients with laparoscopic colorectal cancer surgery and thoracolumbar spinal surgery. Furthermore, perioperative SGB decreased intraoperative requirements for anesthetics and analgesics in patients with complex regional pain syndrome. However, information is scarce regarding the effects of SGB on postoperative quality recovery in patients with breast cancer surgery. Therefore, we investigated the effects of SGB on the postoperative quality of recovery of patients undergoing breast cancer surgery. Sixty patients who underwent an elective unilateral modified radical mastectomy were randomized into two 30-patient groups that received either an ultrasound-guided right-sided SGB with 6 ml 0.25% ropivacaine (SGB group) or no block (control group). The primary outcome was the quality of postoperative recovery 24 hours after surgery, assessed with a Chinese version of the 40-item Quality of Recovery (QoR-40) questionnaire. Secondary outcomes were intraoperative requirements of propofol and opioids, rest pain at two, four, eight, and 24 hours after surgery, patient satisfaction score, and the incidence of postoperative abdominal distension. At 24 hours after surgery, global QoR-40 scores were higher in the SGB group than in the control group. Besides, in the SGB group, patients needed less propofol, had a lower incidence of postoperative abdominal bloating, and had higher satisfaction scores. Ultrasound-guided SGB could improve the quality of postoperative recovery in patients undergoing breast cancer surgery by less intraoperatively need for propofol and better postoperative recovery of sleep and gastrointestinal function.

Pilot Study for Correlation of Heart Rate Variability and Dopamine Transporter Brain Imaging in Patients with Parkinsonian Syndrome

Background: Parkinsonian syndrome (PS) is a broad category of neurodegenerative movement disorders that includes Parkinson disease, multiple system atrophy (MSA), progressive supranuclear palsy, and corticobasal degeneration. Parkinson disease (PD) is the second most common neurodegenerative disorder with loss of dopaminergic neurons of the substantia nigra and, thus, dysfunction of the nigrostriatal pathway. In addition to the motor symptoms of bradykinesia, rigidity, tremors, and postural instability, nonmotor symptoms such as autonomic dysregulation (AutD) can also occur. Heart rate variability (HRV) has been used as a measure of AutD and has shown to be prognostic in diseases such as diabetes mellitus and cirrhosis, as well as PD. I-123 ioflupane, a gamma ray-emitting radiopharmaceutical used in single-photon emission computed tomography (SPECT), is used to measure the loss of dopaminergic neurons in PD. Through the combination of SPECT and HRV, we tested the hypothesis that asymmetrically worse left-sided neuronal loss would cause greater AutD. Methods: 51 patients were enrolled on the day of their standard of care I-123 ioflupane scan for the work-up of possible Parkinsonian syndrome. Demographic information, medical and medication history, and ECG data were collected. HRV metrics were extracted from the ECG data. I-123 ioflupane scans were interpreted by a board-certified nuclear radiologist and quantified by automated software to generate striatal binding ratios (SBRs). Statistical analyses were performed to find correlations between the HRV and SPECT parameters. Results: 32 patients were excluded from the final analysis because of normal scans, prior strokes, cardiac disorders and procedures, or cancer. Abnormal I-123 ioflupane scans were clustered using T-SNE, and one-way ANOVA was performed to compare HRV and SBR parameters. The analysis was repeated after the exclusion of patients taking angiotensin-converting enzyme inhibitors, given the known mechanism on autonomic function. Subsequent analysis showed a significant difference between the high-frequency domains of heart rate variability, asymmetry of the caudate SBR, and putamen-to-caudate SBR. Conclusion: Our results support the hypothesis that more imbalanced (specifically worse left-sided) neuronal loss results in greater AutD.

Stellate ganglion blockade for treating refractory electrical storm: a historical cohort study

BACKGROUND

Stellate ganglion blockade (SGB) has been used to treat electrical storm (ES) refractory to antiarrhythmic therapy or to stabilize patients before more definitive intervention. Nevertheless, its efficacy is not well understood, with only a few case reports and retrospective case series in the literature.

METHODS

We conducted a historical cohort study on patients with drug-refractory ES who underwent ultrasound-guided unilateral SGB from 1 January 2010 until 19 July 2019 at two hospital sites. Stellate ganglion blockade was performed with variable combinations of bupivacaine, lidocaine, ropivacaine, and dexamethasone. We collected data on demographic and procedural characteristics, the number of arrhythmias and defibrillation episodes, antiarrhythmic and anticoagulant medication, left ventricular ejection fraction (EF), and respiratory support requirement.

RESULTS

We identified N = 13 patients; their mean (standard deviation [SD]) age was 64 (13) yr, and 10 (77%) were male. The baseline mean (SD) number of overall arrhythmia and defibrillation episodes per day were 9 (6) and 4 (3), respectively; the mean (SD) pre-SGB EF was 23 (7)%. Seven patients (54%) received dexamethasone in addition to local anesthetic for SGB. One patient experienced hypotension after SGB. Arrhythmias and defibrillation episodes significantly decreased at 24, 48, 72, and 96 hr after SGB; at 96 hr, 62% and 92% of patients had no VA and defibrillation episodes, respectively (P < 0.001 for all time points). Ejection fraction and the number of patients receiving antiarrhythmic medications or requiring respiratory support were unchanged.

CONCLUSIONS

Unilateral SGB was associated with a reduction in arrhythmias and defibrillation episodes, but did not affect antiarrhythmic medication, respiratory support, or EF. Randomized controlled trials on larger cohorts are needed to confirm these findings.