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Role of Stellate Ganglion Ablation in Refractory Ventricular Tachycardia Storm: A Systematic Review and Meta-Analysis
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  • Elio Assaad Saad,
  • Maria Fernanda Hashimoto-Vargas,
  • Paul Bassil,
  • Peter Raffoul,
  • Peter Samuel,
  • Emily Barham,
  • Steven Jacobs,
  • Mohamad A. Kalot
Elio Assaad Saad
University of Balamand Faculty of Medicine and Medical Sciences
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Maria Fernanda Hashimoto-Vargas
Universidad Peruana de Ciencias Aplicadas Facultad de Ciencias de la Salud
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Paul Bassil
Universite Libanaise Faculte des Sciences
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Peter Raffoul
Universite Libanaise Faculte des Sciences
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Peter Samuel
Tbilisi State Medical University Faculty of Medicine
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Emily Barham
Jordan University of Science and Technology Faculty of Medicine
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Steven Jacobs
Geisinger Medical Center Health Sciences Library
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Mohamad A. Kalot
Geisinger Medical Center Health Sciences Library

Corresponding Author:[email protected]

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Abstract

Background: Ventricular tachycardia storm, defined as recurrent and sustained episodes of ventricular tachycardia leading to hemodynamic instability, is a life-threatening condition with complex management. It is often resistant to multiple therapeutic options, leading to high recurrence and mortality rates. This condition thus imposes significant clinical challenges and necessitates novel approaches. Stellate Ganglion Blockade (SGB) has been reported as a new procedure with promising results. Objective: This systematic review aims to explore the role of stellate ganglion blockade in refractory ventricular tachycardia storm as a therapeutic option by assessing its efficacy, safety, and associated outcomes. Methods: A systematic search was conducted on MEDLINE and Embase, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search strategy relied on PICO model (Population, Intervention, Comparison, Outcomes). Two independent reviewers screened the articles for inclusion & exclusion criteria. Data extraction was conducted for included articles using a standardized data extraction form. All included articles were assessed for their risk of bias with appropriate tools according to their study design. Results: 20 studies were included, representing a pooled sample size of 463 participants. Eleven studies reported the occurrence of ventricular tachycardia and arrhythmias within 72 hours of SGB, with 50.69% of their participants experiencing that occurrence. The calculated odds ratio (OR) for refractory ventricular arrhythmia (VA) occurrence, when compared to standard therapy such as stellate ganglion stimulation or antiarrhythmic medications, is 0.33 (95% CI 0.07-1.44). A favorable OR of 0.35 (95% CI 0.03-3.84) was also calculated for VA recurrence in less than 72 hours after intervention, comparing stellate ganglion blockade to other interventions. 44.22% of participants in studies that reported the occurrence of Horner Syndrome were symptomatic. However, combined with studies reporting independent ptosis, the percentage of participants experiencing Horner Syndrome and/or ptosis falls to 30.1%. Only seven studies reported periprocedural and/or postprocedural complications, with most reporting studies mentioning few to no complications. Furthermore, most complications seemed to resolve within a 2-week to 1-month timeframe. As for cardiovascular mortality following SGB, among the studies reporting it, an OR of 0.21 (95%CI 0.07-0.68) was calculated, favoring the blockade over stimulation or IKr-channel blocker administration in this specific outcome. The odds ratio for all-cause mortality also appeared to be lower in SGB groups than in other interventions/controls, with an odds ratio of 0.03 (95% CI 0.01-0.2). Conclusion: SGB is an effective therapy with a limited side effect profile for patients with refractory ventricular tachycardia storm when considering all-cause mortality as compared to standard therapy. Further long-term data is still needed to consolidate these findings.
Submitted to Journal of Cardiovascular Electrophysiology
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