Stellate Ganglion Block for the Treatment of Refractory Ventricular Tachycardia and Electrical Storm: A Narrative Review.

Contemporary management of refractory ventricular arrhythmias and electrical storm (ES) emphasizes antiarrhythmic therapy, autonomic modulation, sedation, catheter ablation, mechanical circulatory support, and heart transplantation. The stellate ganglion block (SGB) has been used for decades to treat refractory ventricular tachycardia (VT) and ventricular fibrillation (VF), and has gained more traction in the literature in recent years. The authors summarize the anatomy of the stellate ganglion, the mechanism of action of an SGB, and the physiology of VT, VF and ES. They then review current practices for the treatment of VT and VF and review the current literature supporting the use of SGB as treatment for refractory VT and VF. Finally, they describe practical considerations for the use of SGB for the treatment of VT and VF. Multiple observational studies, case series, retrospective studies, and meta-analyses in recent years have shown that SGB can be effective at reducing arrhythmia episodes in patients with refractory VT or VF; however, the quality of the available literature is weak because of the lack of randomized controlled trials. Despite this, the SGB may play a role as a bridge therapy in patients with refractory VT between initial stabilization and further long-term management.