AIMS: One treatment option for refractory ventricular arrythmias is stellate ganglion block (SGB). We examined differences in SGB success by patient and arrhythmia characteristics and predictors of successful SGB. METHODS AND RESULTS: This was a multicenter analysis of patients treated for refractory ventricular arrythmias in the Czech Republic and the United States. The primary outcome was absence of ventricular arrythmias at 24 h post SGB. SGB effectiveness was examined according to aetiology of cardiomyopathy, arrhythmia type, laterality of SGB, presence of inotropes, and presence of mechanical circulatory support. Binary logistic regression was used to examine variables associated with the primary outcome. In total there were 117 patients with refractory ventricular arrythmias treated with SGB. Overall, the mean age was 63.5 ± 11.0 years, majority of patients were male (94.0%), White (87.2%), and had an implantable cardioverter defibrillator in situ (70.1%). There were no differences in efficacy of SGB based on aetiology of cardiomyopathy (P = 0.623), arrhythmia type (0.852), laterality of block (P = 0.131), and presence of inotropes (P = 0.083). Multivariable analysis demonstrated that increased age was associated with decreased odds of SGB success (odds ratio: 0.96, confidence interval: 0.92-0.99, P = 0.039) whereas increased left ventricular ejection fraction trended towards increased odds of SGB success (odds ratio: 1.05, confidence interval: 0.995-1.11, P = 0.077). CONCLUSIONS: In this multicentre experience, SGB was similarly effective despite the aetiology of cardiomyopathy, type of arrhythmia, laterality, and inotropic or mechanical support. SGB was less effective for the suppression of ventricular arrythmias at 24 h for the elderly.

Department of Anesthesiology Duke University School of Medicine Durham North Carolina USA

Department of Internal Medicine Division of Cardiology Duke University School of Medicine Durham North Carolina USA

Division of Cardiovascular Medicine Brigham and Women's Hospital Boston Massachusetts USA

Duke Clinical Research Institute Durham North Carolina USA

Institute for Clinical and Experimental Medicine Prague Czech Republic

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Franciosi S, Perry FKG, Roston TM, Armstrong KR, Claydon VE, Sanatani S. The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Auton Neurosci 2017;205:1‐11. doi:10.1016/j.autneu.2017.03.005 PubMed DOI

Fudim M, Boortz‐Marx R, Patel CB, Sun AY, Piccini JP. Autonomic modulation for the treatment of ventricular arrhythmias: therapeutic use of percutaneous stellate ganglion blocks. J Cardiovasc Electrophysiol 2017;28:446‐449. doi:10.1111/jce.13152 PubMed DOI

Bradfield JS, Ajijola OA, Vaseghi M, Shivkumar K. Mechanisms and management of refractory ventricular arrhythmias in the age of autonomic modulation. Heart Rhythm 2018;15:1252‐1260. doi:10.1016/j.hrthm.2018.02.015 PubMed DOI

Chouairi F, Rajkumar K, Benak A, Qadri Y, Piccini JP, Mathew J, et al. A multicenter study of stellate ganglion block as a temporizing treatment for refractory ventricular arrhythmias. JACC Clin Electrophysiol 2024;10:750‐758. doi:10.1016/j.jacep.2023.12.012 PubMed DOI

Fudim M, Qadri YJ, Waldron NH, Boortz‐Marx RL, Ganesh A, Patel CB, et al. Stellate ganglion blockade for the treatment of refractory ventricular arrhythmias. JACC Clin Electrophysiol 2020;6:562‐571. doi:10.1016/j.jacep.2019.12.017 PubMed DOI

Ganesh A, Qadri YJ, Boortz‐Marx RL, Al‐Khatib SM, Harpole DH Jr, Katz JN, et al. Stellate ganglion blockade: an intervention for the management of ventricular arrhythmias. Curr Hypertens Rep 2020;22:100. PubMed PMC

Tavazzi G, Dammassa V, Colombo CNJ, Arbustini E, Castelein T, Balik M, et al. Mechanical circulatory support in ventricular arrhythmias. Front Cardiovasc Med 2022;9:987008. doi:10.3389/fcvm.2022.987008 PubMed DOI PMC

Rehorn MR, Black‐Maier E, Loungani R, Sen S, Sun AY, Friedman DJ, et al. Electrical storm in patients with left ventricular assist devices: risk factors, incidence, and impact on survival. Heart Rhythm 2021;18:1263‐1271. doi:10.1016/j.hrthm.2021.03.047 PubMed DOI

Harding JD, Piacentino V 3rd, Rothman S, Chambers S, Jessup M, Margulies KB. Prolonged repolarization after ventricular assist device support is associated with arrhythmias in humans with congestive heart failure. J Card Fail 2005;11:227‐232. doi:10.1016/j.cardfail.2004.08.158 PubMed DOI

Burzotta F, Trani C, Doshi SN, Townend J, van Geuns RJ, Hunziker P, et al. Impella ventricular support in clinical practice: collaborative viewpoint from a European expert user group. Int J Cardiol 2015;201:684‐691. doi:10.1016/j.ijcard.2015.07.065 PubMed DOI

Rengo G, Pagano G, Vitale DF, Formisano R, Komici K, Petraglia L, et al. Impact of aging on cardiac sympathetic innervation measured by (123)I‐mIBG imaging in patients with systolic heart failure. Eur J Nucl Med Mol Imaging 2016;43:2392‐2400. doi:10.1007/s00259-016-3432-3 PubMed DOI

de Lucia C, Piedepalumbo M, Paolisso G, Koch WJ. Sympathetic nervous system in age‐related cardiovascular dysfunction: pathophysiology and therapeutic perspective. Int J Biochem Cell Biol 2019;108:29‐33. doi:10.1016/j.biocel.2019.01.004 PubMed DOI PMC

Weidner K, Schupp T, Rusnak J, El‐Battrawy I, Ansari U, Hoppner J, et al. Impact of age on the prognosis of patients with ventricular tachyarrhythmias and aborted cardiac arrest. Z Gerontol Geriatr 2023;56:484‐491. doi:10.1007/s00391-022-02131-6 PubMed DOI PMC

Koplan BA, Stevenson WG. Ventricular tachycardia and sudden cardiac death. Mayo Clin Proc 2009;84:289‐297. doi:10.4065/84.3.289 PubMed DOI PMC

Zekios KC, Mouchtouri ET, Lekkas P, Nikas DN, Kolettis TM. Sympathetic activation and arrhythmogenesis after myocardial infarction: where do we stand? J Cardiovasc Dev Dis 2021;8:57. doi:10.3390/jcdd8050057 PubMed DOI PMC