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Dusi V, Angelini F, Baldi E, Toscano A, Gravinese C, Frea S, Compagnoni S, Morena A, Saglietto A, Balzani E, Giunta M, Costamagna A, Rinaldi M, Trompeo AC, Rordorf R, Anselmino M, Savastano S, De Ferrari GM. Continuous stellate ganglion block for ventricular arrhythmias: case series, systematic review, and differences from thoracic epidural anaesthesia. Europace 2024; 26:euae074. [PMID: 38531027 PMCID: PMC11020261 DOI: 10.1093/europace/euae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS Percutaneous stellate ganglion block (PSGB) through single-bolus injection and thoracic epidural anaesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). However, data on continuous PSGB (C-PSGB) are scant. The aim of this study is to report our dual-centre experience with C-PSGB and to perform a systematic review on C-PSGB and TEA. METHODS AND RESULTS Consecutive patients receiving C-PSGB at two centres were enrolled. The systematic literature review follows the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Our case series (26 patients, 88% male, 60 ± 16 years, all with advanced structural heart disease, left ventricular ejection fraction 23 ± 11%, 32 C-PSGBs performed, with a median duration of 3 days) shows that C-PSGB is feasible and safe and leads to complete VAs suppression in 59% and to overall clinical benefit in 94% of cases. Overall, 61 patients received 68 C-PSGBs and 22 TEA, with complete VA suppression in 63% of C-PSGBs (61% of patients). Most TEA procedures (55%) were performed on intubated patients, as opposed to 28% of C-PSGBs (P = 0.02); 63% of cases were on full anticoagulation at C-PSGB, none at TEA (P < 0.001). Ropivacaine and lidocaine were the most used drugs for C-PSGB, and the available data support a starting dose of 12 and 100 mg/h, respectively. No major complications occurred, yet TEA discontinuation rate due to side effects was higher than C-PSGB (18 vs. 1%, P = 0.01). CONCLUSION Continuous PSGB seems feasible, safe, and effective for the acute management of refractory VAs. The antiarrhythmic effect may be accomplished with less concerns for concomitant anticoagulation compared with TEA and with a lower side-effect related discontinuation rate.
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Affiliation(s)
- Veronica Dusi
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Enrico Baldi
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Toscano
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Carol Gravinese
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Viale Golgi 19, 27100 Pavia, Italy
| | - Arianna Morena
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Matteo Giunta
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Andrea Costamagna
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Mauro Rinaldi
- Department of Surgical Sciences, University of Turin, Torino, Italy
- Department of Cardiovascular and Thoracic Surgery, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Anna Chiara Trompeo
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Roberto Rordorf
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Anselmino
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Simone Savastano
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gaetano Maria De Ferrari
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
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Cauti FM, Rossi P, Bianchi S, Magnocavallo M, Capone S, Della Rocca DG, Polselli M, Bruno K, Tozzi P, Rossi C, Vannucci J, Pugliese F, Quaglione R, Venuta F, Anile M. Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01706-6. [PMID: 38040851 DOI: 10.1007/s10840-023-01706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Modified cardiac sympathetic denervation (CSD) with stellate ganglion (SG) sparing is a novel technique for cardiac neuromodulation in patients with refractory ventricular tachycardia (VT). OBJECTIVES Our aim is to describe the mid- to long-term clinical outcome of the modified CSD with SG sparing in a series of patients with structural heart disease (SHD) and refractory VT. METHODS All consecutive patients with SHD and refractory VT undergoing modified CSD were enrolled. Baseline clinical characteristics and periprocedural data were collected for all patients. The primary outcome was any recurrence of sustained VT. RESULTS We enrolled 15 patients (age: 69.2 ± 7.9 years; male 100%) undergoing modified CSD. Left ventricular ejection fraction was 37 ± 11% and all patients had an implantable cardiac defibrillator (ICD); the underlying cardiomyopathy was non-ischemic in 73.3% of them. At least one previous ablation had been attempted in 66.6% of cases. The 73.3% of patients underwent bilateral CSD and the mean effective surgical time was 10.8 ± 2.4 min per side; no major periprocedural complication occurred. After a median follow-up time of 15 months (IQR: 8.5-24.5 months), the primary outcome occurred in 47.6% of cases. All patients experienced a reduction of ICD shocks after CSD (3.1 ICD shocks/patient before vs. 0.3 ICD shocks/patient after CSD; p-value: 0.001). Bilateral CSD and a VT cycle length < 340 ms were associated with better outcomes. CONCLUSIONS A modified CSD approach with stellate ganglion sparing appears to be safe, fast, and effective in the treatment of patients with SHD and refractory VTs.
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Affiliation(s)
- Filippo Maria Cauti
- Arrhythmology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy.
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | | | - Silvia Capone
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard - Heart, Brussels, Belgium
| | - Marco Polselli
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Sapienza University, Rome, Italy
| | | | - Chiara Rossi
- Presidio Ospedaliero Santo Spirito in Sassia, Rome, Italy
| | - Jacopo Vannucci
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
| | | | - Raffaele Quaglione
- Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
| | - Marco Anile
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
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