Ultrasound-guided stellate ganglion block in patients with electrical storm: A single-center case series

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-05-02 DOI:10.1016/j.jclinane.2025.111850

Jun Zhang , Jingwen Liang , Tieshuai Liu , Xinru Lin , Jiwen Li , Shameera Sayer , Yunhe Wang , Qihong Shen , Xin Yu , Gang Chen

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Abstract

Study objective

Increasing evidence suggests that stellate ganglion block (SGB) for the treatment of electrical storm (ES) shows encouraging effectiveness. This study aimed to evaluate the effects of SGB in patients with ES.

Design

A single-center case series.

Setting

Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.

Patients

ES Patients with SGB treated between July 2023 and July 2024.

Interventions

Patients with ES received SGB.

Measurements

The primary outcomes included changes in sustained ventricular arrhythmias and anti-tachycardia pacing (ATP) or defibrillation shocks within 24 h before and after SGB. Effectiveness was defined as a ≥ 50 % reduction in these events post-block.

Main results

Between July 2023 and July 2024, 20 patients with ES underwent SGB. Among them, 60 % had persistent ES following catheter ablation, 20 % were diagnosed upon emergency admission, and 15 % developed ES after cardiac surgery.

Within 24 h of the first SGB, the median (interquartile range, IQR) number of sustained ventricular arrhythmias decreased from 4.5 (3.0–13.0) to 0 (0–1.0), (median difference = −5.5, 95 % confidence interval [CI] = −9.5 to −3.0, p = 0.001), with an effectiveness rate of 80.0 %. Similarly, ATP or shocks decreased from 1.5 (0–4.0) to 0 (0–0.75), (median difference = −2.0, 95 % CI = −4.5 to −0.5, p = 0.011), indicating an effectiveness rate of 78.6 %.

Compared to baseline levels, within 24 h after the last SGB, the median (IQR) number of sustained ventricular arrhythmias significantly decreased from 4.5 (3.0–13.0) to 0 (0–0.75), (median difference = −5.0, 95 % CI = −10.5 to −2.5, p = 0.004), achieving an effectiveness rate of 80.0 %. Likewise, ATP or shock events declined from 1.5 (0–4.0) to 0 (0–0), (median difference = −1.75, 95 % CI = −12.5 to −0.5, p = 0.028), reflecting an effectiveness rate of 86.7 %.

In this study, 10 % of patients experienced minor complications after SGB, including one case of hoarseness and another case of phrenic nerve block. Both fully recovered without sequelae.

Conclusions

SGB appears to be a safe and effective treatment that may provide temporary stabilization between the onset of ES and catheter ablation, while also aiding in the management of persistent ES post-catheter ablation and newly developed ES following cardiac surgery.

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超声引导下星状神经节阻滞在电风暴患者中的应用：单中心病例系列

研究目的越来越多的证据表明，星状神经节阻滞（SGB）治疗电风暴（ES）的效果令人鼓舞。本研究旨在评估SGB在ES患者中的作用。DesignA单中心机箱系列。浙江大学医学院邵逸夫爵士医院。在2023年7月至2024年7月期间接受SGB治疗的患者。干预措施ES患者接受SGB治疗。主要结果包括SGB前后24小时内持续性室性心律失常和抗心动过速起搏（ATP）或除颤冲击的变化。有效性定义为阻滞后这些事件减少≥50%。主要结果2023年7月至2024年7月，20例ES患者行SGB手术。其中60%在导管消融后出现持续性ES， 20%在急诊入院时确诊，15%在心脏手术后出现ES。在第一次SGB后24小时内，持续室性心律失常的中位数（四分位间距，IQR）从4.5例（3.0 - 13.0）降至0例（0 - 1.0），（中位数差= - 5.5,95%可信区间[CI] = - 9.5 - - 3.0, p = 0.001），有效率为80.0%。同样，ATP或冲击从1.5（0 - 4.0）降至0(0 - 0.75),（中位数差异= - 2.0,95% CI = - 4.5至- 0.5,p = 0.011），表明有效率为78.6%。与基线水平相比，在最后一次SGB后24小时内，持续室性心律失常的中位（IQR）数从4.5（3.0-13.0）显著降低到0(0 - 0.75),（中位差= - 5.0,95% CI = - 10.5至- 2.5,p = 0.004），有效率为80.0%。同样，ATP或休克事件从1.5（0 - 4.0）下降到0(0 - 0),（中位数差异= - 1.75,95% CI = - 12.5至- 0.5,p = 0.028），反映了86.7%的有效率。在本研究中，10%的患者在SGB后出现轻微并发症，包括一例声音嘶哑和一例膈神经阻滞。两人均完全康复，无后遗症。结论ssgb似乎是一种安全有效的治疗方法，可以在ES发作和导管消融之间提供暂时的稳定，同时也有助于管理导管消融后持续ES和心脏手术后新发生的ES。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.