Role of stellate ganglion block in refractory ventricular arrhythmias

Stellate ganglion block is being increasingly used as a modality for treatment of drug refractory ventricular tachycardia. It is a simple bedside procedure which can very well be done in the cardiac intensive care unit. High resolution ultrasound guidance is useful and often utilized by the anaesthesiologist. Temporary blockage of stellate ganglion can be obtained by injection or lignocaine or bupivacaine for longer effect [1]. Sometimes a cannula can be left in situ and a local anesthetic infusion started for a prolonged effect. A multicenter registry evaluated the role of stellate ganglion block as a temporizing treatment for refractory ventricular arrhythmias [2].

Data collection was between 2016 and 2022 and the procedure was performed at the bedside by anaesthesiologists and/or cardiologists. Burden of ventricular tachycardia and fibrillation and defibrillations at 24 hours after stellate ganglion block were the outcomes of interest. Of the 117 patients with refractory ventricular arrhythmias treated, 70.1% had an implantable cardioverter defibrillator. Ischemic cardiomyopathy was the commonest etiology of heart disease and was noted in 52.1% and monomorphic ventricular tachycardia was the most common arrhythmia morphology, found in 70.1%. Atuhors concluded that stellate ganglion block was associated with a reduction in ventricular arrhythmia burden and need for defibrillation in this large cohort of drug refractory ventricular arrhythmia. Utility of stellate ganglion block is because autonomic tone contributes to the initiation of ventricular arrhythmias.

Large majority received either bupivacaine or ropivacaine, with lignocaine only in a very small number. Bilateral block and repeat injections were needed in some cases. Brachial plexus block and recurrent laryngeal nerve block were rare complications noted. Both resolved in a day without any other intervention. There were no occurences of hematoma, pneumothorax or infection associated with stellate ganglion block in the study. Those who had more than 50% reduction in arrhythmia burden also had lower in-hospital mortality.

1. Lingjin Meng, Chi-Hong Tseng, Kalyanam Shivkumar, Olujimi Ajijola. Efficacy of Stellate Ganglion Blockade in Managing Electrical Storm: A Systematic Review. JACC Clin Electrophysiol. 2017 Sep;3(9):942-949.
2. Chouairi F, Rajkumar K, Benak A, Qadri Y, Piccini JP, Mathew J, Ray ND, Toman J, Kautzner J, Ganesh A, Sramko M, Fudim M. A Multicenter Study of Stellate Ganglion Block as a Temporizing Treatment for Refractory Ventricular Arrhythmias. JACC Clin Electrophysiol. 2024 Feb 2:S2405-500X(24)00008-2. doi: 10.1016/j.jacep.2023.12.012. Epub ahead of print. PMID: 38363278.