Role of Stellate Ganglion Ablation in Refractory Ventricular Tachycardia
Storm: A Systematic Review and Meta-Analysis
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.