Stellate ganglion blockade for the treatment of refractory ventricular arrhythmias: A systematic review and meta‐analysis
Ventricular tachycardia (VT), ventricular fibrillation (VF), and electrical storm can be difficult to treat and may be refractory to β‐blockade, antiarrhythmic therapy, sedation, and mechanical hemodynamic support. While monomorphic VT and PVC‐triggered polymorphic VT can be successfully treated with ablation, some patients may be too critically ill or unstable to make such an approach immediately feasible. Given the significant role of the sympathetic nervous system in the initiation of ventricular arrhythmias (VAs), surgical sympathetic denervation (i.e., sympathectomy) has been applied in patients with refractory VAs with some success.1 However, in the setting of electrical storm, patients may not be able to acutely undergo surgical sympathectomy, and thus this therapy is often out of reach for many patients. Another approach to interrupt cardiac innervation targets the cervical sympathetic ganglia (stellate ganglion). Percutaneous stellate ganglion block (SGB) is a less invasive approach to sympathetic blockade and has been reported in the literature as early as the 1970s.4 Percutaneous SGB can potentially be used as a therapeutic intervention or a screening test in patients who could benefit from subsequent surgical sympathectomy. To date, there are no randomized controlled studies of SGB for the treatment of recurrent, treatment refractory VAs. We sought to perform a systematic review and meta‐analysis of the reported case studies to better understand the impact of SGB on VA burden, the applied techniques, and the population in which it has been used.