Stellate ganglion blockade for the treatment of refractory ventricular arrhythmias: A systematic review and meta‐analysis. (1st September 2017) - Fudim, Marat
Abstract: Introduction: Treatment refractory ventricular arrhythmias (VAs) are often driven and exacerbated by heightened sympathetic tone. We aim to conduct a systematic review and meta‐analysis of published studies of a temporary percutaneous stellate ganglion block (SGB) on VA burden and defibrillation episodes in patients with treatment refractory VAs. Methods: Relevant studies from January 1960 through May 2017 were identified in PubMed and Google Scholar. We performed a patient‐level analysis using Student's t ‐test to compare outcomes before and after SGB. Results: We identified 22 unique case series with a total of 35 patients. Patients were 57 ± 17 years old and 69% were males with a high burden of VA. A unilateral (left)‐sided SGB was used in 85.7% (30 of 35) of cases and the remaining were bilateral SGB. The use of a unilateral or bilateral SGB resulted in a significant reduction of VA episodes (24‐hours pre: mean 16.5 [CI 9.7–23.1] events vs. post: mean 1.4 [CI 0.85–2.01] events; P = 0.0002) and need for defibrillation (24‐hours pre: mean 14.2 [CI 6.8–21.6] vs. post: mean 0.6 [CI 0.3–0.9]; P = 0.0026). Furthermore, SGB was significantly associated with a reduction of VA burden regardless of etiology of cardiomyopathy, type of ventricular rhythm, and degree of contractile dysfunction. SGB was followed by surgical sympathectomy in 21% of cases. Conclusions: Early experience suggests that SGB is associated with an acute reduction in the VA burden and offers potential promise for a broader use in high‐risk populations. Randomized controlled studies are needed to confirm the safety and efficacy of this therapy.