Stellate Ganglion Blockade With Continuous Infusion Versus Single Injection for Treatment of Ventricular Arrhythmia Storm
| Autor: | Julio A. Gonzalez-Sotomayor, Saket Sanghai, Michael Wollenberg, Babak Nazer, Charles A. Henrikson, Ryan Ivie, Nicholas James Abbott, Miriam R. Elman, Thomas A. Dewland |
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| Rok vydání: | 2021 |
| Předmět: |
Continuous infusion
medicine.drug_class Stellate Ganglion 030204 cardiovascular system & hematology Ventricular tachycardia 03 medical and health sciences 0302 clinical medicine Interquartile range medicine Humans 030212 general & internal medicine Adverse effect business.industry Local anesthetic Arrhythmias Cardiac Middle Aged medicine.disease Blockade medicine.anatomical_structure Stellate ganglion Anesthesia Ventricular Fibrillation Ventricular fibrillation Tachycardia Ventricular business Autonomic Nerve Block |
| Zdroj: | JACC: Clinical Electrophysiology. 7:452-460 |
| ISSN: | 2405-500X |
| DOI: | 10.1016/j.jacep.2020.09.032 |
| Popis: | Objectives This study sought to compare the efficacy and safety of single-injection stellate ganglion block (SGB) with a novel continuous-infusion SGB procedure. Background SGB for ventricular arrhythmia (VA) storm is typically performed with a single injection of local anesthetic agents. Methods Eighteen patients underwent left-sided SGB (9 single injection and 9 continuous infusion). The number of implantable cardioverter-defibrillator therapies and sustained VAs/24 h were compared between the pre-SGB and post-SGB periods. Adverse effects of SGB and in-hospital outcomes were also compared. Results The mean age was 61.1 ± 13.7 years. The presenting arrhythmia was ventricular tachycardia in 13 (72%) patients, ventricular fibrillation in 4 (22%), and both in 1 (6%). Single-injection SGB reduced VA/24 h by a median of 0.3 (interquartile range: 0.2 to 0.9), which was a 45% reduction (p = 0.008), resulting in 5 of 9 patients with no recurrent VA. Continuous-infusion SGB reduced VA/24 h by a median of 2.0 (interquartile range: 1.3 to 3.0), which was a 94% reduction (p = 0.004), resulting in 7 of 9 patients with no recurrent VA (p = 0.006 for comparison with single injection). Transient left arm weakness and voice hoarseness were each noted in 1 patient in both groups. Repeat SGB was required in 4 (44%) patients in the single-injection group. In-hospital outcomes were similar between the groups. Conclusions In patients with VA storm, SGB performed via both continuous-infusion and single-injection approaches provided significant reductions in VA burden. Compared to single-injection SGB, continuous-infusion was associated with a greater reduction in VA burden and similar adverse events, without the need for repeat procedures. |
| Databáze: | OpenAIRE |
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