Percutaneous left stellate ganglion block for acute supraventricular arrhythmias management: insights from a single-center experience

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Abstract Background The efficacy of percutaneous left stellate ganglion block (PLSGB) for drug-refractory electrical storm is well established. However, its potential benefit for supraventricular arrhythmias (SVAs), supported by animal models, is still unexplored in humans. We’ve recently started to expand its usage to SVAs. Purpose to explore the feasibility and efficacy of PLSGB for the acute control of SVAs. Methods We hereby describe our single center experience of PLSGB for SVAs from 2/2021 to 02/2025. Results Among 92 patients treated with ultrasound guided PSGB, 15 (86% male, mean age 72 years) underwent a total of 16 PLSGBs (15 as single bolus and 1 as continuous infusion with 1% ropivacaine) for acute onset of SVAs. Thirteen procedures were performed for atrial fibrillation (AF), and one each for 2:1 atrial flutter, atrial tachycardia (AT), and supraventricular (SV) bigeminism. Most patients (73%) suffered ischemic cardiomyopathy (CMP), including 4 with an ongoing acute coronary syndrome (ACS), the remaining had non-ischemic CMP. The main SVAs trigger was acute decompensated heart failure (60% of patients), followed by ACS, Takotsubo syndrome and 1 case of post-operative coronary artery bypass surgery. PLSGB was performed for its negative dromotropic effect as well as its potential to facilitate cardioversion (CV) in patients with high risk of/ongoing hemodynamic instability. Ten patients (67%) were receiving inotropes, and two required intra-aortic balloon pump support. Despite ongoing treatment with beta-blockers and amiodarone, SVAs had a mean ventricular cycle of 442 ± 61 ms. Most PLSGB (75%) were performed in the setting of impending or manifest cardiogenic shock (SCAI classification B or more), including 25% with concurrent sepsis. Most of them had biventricular impairment: mean LVEF was 30 ± 11% and mean right ventricle fractional area change 32 ± 7%. Among AF patients, 7 procedures were performed for new-onset AF (AF), the remaining 6 for a pre-existing persistent AF exacerbation. PLSGB resulted in cardioversion into sinus rhythm within 1 hour (mostly within few minutes) in 54% of them (7/13, all of which had new-onset AF), in the others (6/13) as well as the case of AT, PLSGB significantly reduced ventricular rate during AF/AT (mean 37% reduction) allowing for hemodynamic stabilization. Notably, in one AF patient, PLSGB enabled successful electrical CV after previous failed attempts. Additionally, PLSGB permitted complete suppression of SV premature complexes, though it had no effect in the single case of 2:1 atrial flutter. Overall, 12 hours-efficacy of PLSGB in rhythm/rate control was 87%. Conclusions Our preliminary data suggest that PLSGB usage, due to its easy feasibility and rapid effect, may be effective in the acute management of drug refractory SVAs either by facilitating spontaneous or electrical CV and/or by reducing ventricular response.

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