Stellate Ganglion Blockade for Refractory Ventricular Arrhythmias: Implications of Ultrasound-Guided Technique and Review of the Evidence

Refractory ventricular arrhythmias (VAs) carry high mortality rates despite electrical and pharmacologic therapy utilization. These patients often require aggressive hemodynamic support, including mechanical circulatory devices such as extracorporeal membrane oxygenation because of progressive hemodynamic and metabolic deterioration. Sympathetic nervous system stimulation and neuronal remodeling after myocardial insults have been implicated as drivers of refractory VAs. This understanding has led to interest in and a growing body of experience with percutaneous blockade of the stellate ganglion as a means of interrupting the vicious cycle of refractory VAs.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research

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AbstractThe ligament of Marshall (LOM) is a remnant of the embryonic sinus venosus and left cardinal vein, and contains fat and fibrous tissues, blood vessels, muscle bundles, nerve fibers, and ganglia. The complexity of LOM's structure makes it as a source of triggers and drivers as well as substrates of re ‐entry for atrial arrhythmias, especially for atrial fibrillation (AF). LOM also serves as a portion of left atrial macro‐re‐entrant circuit, especially peri‐mitral isthmus re‐entrant circuit. Experimental studies demonstrate that the LOM acts as a sympathetic conduit between the left stel late ganglion and t...
Source: Pacing and Clinical Electrophysiology : PACE - Category: Cardiology Authors: Tags: REVIEW Source Type: research
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Source: Pacing and Clinical Electrophysiology : PACE - Category: Cardiology Authors: Tags: REVIEW Source Type: research
In this study, 20 dogs were included and randomly divided into the LIFU (LIFU &MI, n = 8), Sham (sham LIFU &MI, n = 8), and Control group (sham LIFU &sham MI, n = 4). For each LIFU intervention (1.0–2.0 W, 10 minutes) of the LSG, the LSG function, ventricular effective refractory period (ERP), and temperature were tested pre-intervention and postintervention. Thereafter, MI was induced by left anterior artery ligation and VAs were recorded for 1 hour. At the end, both the LSG and the heart were extracted for biomedical and histological analysis. Results: In the Sham group, no significant change was sho...
Source: Journal of Cardiovascular Pharmacology - Category: Cardiology Tags: Original Article Source Type: research
Authors: Saitoh O, Watanabe J, Sugai A, Oikawa A, Sugai M, Chinushi M Abstract Sympathetic nerve activity has arrhythmogenic potential for ventricular arrhythmias associated with structural heart diseases. However, a sufficient amount of beta-blockers occasionally cannot be prescribed in some patients.An experimental study was performed to clarify the therapeutic effects of bepridil, a multiple ionic current inhibitor that does not affect beta-adrenergic receptors, for premature beats occurring during enhanced sympathetic nerve activity. Cardio-sympathetic nerve activity was augmented via stellate-ganglion (SG) sti...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
This study aimed to investigate the effects of C-type natriuretic peptide (CNP) on ventricular arrhythmias in rats with acute myocardial ischemia (AMI). Forty male Sprague-Dawley rats were randomly divided into sham group (n = 10), AMI group (n = 15) and AMI + CNP group (n = 15). AMI model was induced by ligating the left anterior descending branch of the coronary artery, and CNP was pumped through the femoral vein starting 30 minutes before ischemia and continuing until 1 hour after AMI. The occurrence of ventricular arrhythmias after ischemia and heart...
Source: Peptides - Category: Biochemistry Source Type: research
Rationale: Stellate Ganglion Block (SGB) provides a blockade of sympathetic signals from the sympathetic chain and appears to be a promising method of controlling refractory ventricular arrhythmias, but there are scanty data in the literature. Patient concerns: Herein, we describe a 59-year-old male patient with a history of non-ischemic cardiomyopathy and suffering from frequent VT episodes, who received ICD implantation and regular amiodarone medication control. Diagnoses: Monomorphic VT refractory to standard medication control and focal extensive catheter ablation. Interventions: Left Stellate Ganglion Block...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
CONCLUSION: Collectively, these findings suggest that the increased ventricular arrhythmia susceptibility of type 2 diabetic mouse hearts is due to dysregulation of the sympathetic ventricular control. PMID: 31625779 [PubMed - as supplied by publisher]
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research
ConclusionTargeted ablation of TRPV-1/TH positive sympathetic neurons induced by RTX stellate microinjection could suppress ischemia-induced cardiac autonomic imbalances and cardiac electrophysiology instability to protect against AMI-induced VAs.
Source: Biomedicine and Pharmacotherapy - Category: Drugs & Pharmacology Source Type: research
CONCLUSION: Targeted ablation of TRPV-1/TH positive sympathetic neurons induced by RTX stellate microinjection could suppress ischemia-induced cardiac autonomic imbalances and cardiac electrophysiology instability to protect against AMI-induced VAs. PMID: 31600641 [PubMed - as supplied by publisher]
Source: Biomedicine and pharmacotherapy = Biomedecine and pharmacotherapie - Category: Drugs & Pharmacology Authors: Tags: Biomed Pharmacother Source Type: research
We report the case of a 65-year-old man brought in by ambulance who complained of chest pain and received an out-of-hospital ECG suggestive of anterior-wall ST-segment elevation myocardial infarction. Shortly after arrival, the patient became unresponsive, with no palpable pulse, and was found to be in ventricular fibrillation. The patient’s ventricular fibrillation persisted despite repeated attempts at standard and double sequential defibrillation, multiple rounds of epinephrine, and amiodarone, magnesium, and bicarbonate. After these interventions were exhausted, a stellate ganglion blockade was conducted after an...
Source: Annals of Emergency Medicine - Category: Emergency Medicine Source Type: research
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