Introduction. The treatment of electrical storm is a challenge and the standard treatments are often not enough to control arrhythmic relapses. The sympathetic system plays a pivotal role both in the genesis and in the maintenance of arrhythmias and the bilateral cardiac sympathetic denervation has been shown to be an effective treatment to prevent arrhythmias both in the case of channelopathies and in structural heart diseases. However, this technique is not suitable for an emergency situation but the percutaneous left stellate ganglion block (PSGB) seems to be a promising technique even if data from large series of cases are missing. Aim. We sought to assess the safety and the effectiveness of the percutaneous left stellate ganglion block in a series of patients with electrical storm admitted to Policlinico San Matteo. Material and methods. All the consecutive patients admitted to our institution presenting an electrical storm from November 2017 to August 2019 were enrolled in the study. Electrical storm was defined as the presence of three or more episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in 24 hours. PSGB was performed at the level of the left Chassaignac tubercle by injecting lidocaine or bupivacaine or both at discretion of the operator. The number of procedure related complications was counted and the numbers of DC shock or ATP pre and post procedure were compared with the Wilcoxon test for paired samples. Results. We enrolled 11 patients (age 70±13,4 years; 8 males; 4 with acute myocardial infarction, 1 with arrhythmogenic right ventricle dysplasia and 6 with chronic heart disease; mean ejection fraction 29.4%±14.2%; 6 in chronic therapy with Beta-blockers and 2 with class IV antiarrhythmic drugs; 4 with diabetes). For their treatment 18 PSGB were performed (5 with lidocaine; 5 with bupivacaine e 8 with lidocaine and bupivacaine; 16 as a single bolus and 2 with bolus and infusion). No local or systemic complications occurred. The number of arrhythmic relapses decreased significantly after the PSGB both in the short term (one hour after vs one hour before ) and in the long term (12 hours after vs 12 hours before) (0 IQR 0-0 vs 3 IQR 1-10 p<0.001 and 1 IQR 0-2 vs 8 IQR 4-12 p =0.02 respectively). Conclusions. Our results confirm the effectiveness and the safety of the percutaneous left stellate ganglion block for the treatment of refractory electric storm.
Introduzione. La gestione dello storm aritmico è molto complessa e i trattamenti standard sono spesso insufficienti a controllare le recidive aritmiche. Il sistema nervoso simpatico gioca un ruolo centrale sia nella genesi sia nel mantenimento delle aritmie e la denervazione cardiaca bilaterale ha dimostrato di essere un trattamento efficace nella prevenzione delle aritmie sia nel caso di canalopatie sia nel caso cardiopatie strutturali. Questa tecnica non è però attuabile in situazioni di emergenza, ma il blocco percutaneo del ganglio stellate di sinistra (PSGB) sembra essere una tecnica promettente nonostante la mancanza di dati da serie di casi ampie. Obiettivo. Valutare la sicurezza e lefficacia del blocco percutaneo del ganglio stellato di sinistra in una serie di pazienti con storm aritmico ricoverati presso il Policlinico San Matteo. Materiali e metodi. Tutti i pazienti ricoverati presso il nostro istituto che hanno presentato uno storm aritmico da Novembre 2017 ad Agosto 2019 sono stati arruolati nello studio. Lo storm aritmico è stato definito come la presenza di tre o più episodi di tachicardia ventricolare (TV) o fibrillazione ventricolare (FV) in 24 ore. Il PSGB è stato effettuato a livello del tubercolo di Chassignac di sinistra iniettando lidocaina o bupivacaina o entrambi i farmaci a discrezione delloperatore. É stato contato il numero di complicanze legate alla procedura ed è stato confrontato il numero di DC shock o ATP pre e post procedura con il test di Wilcoxon per campioni appaiati. Risultati: Sono stati arruolati 11 pazienti (età 70±13.4 anni; 8 uomini; 4 con infarto miocardico acuto, 1 con displasia aritmogena del ventricolo destro e 6 con cardiopatia cronica; frazione di eiezione media 29.4%±14.2%; 6 in terapia cronica con beta-bloccanti e 2 con farmaci antiaritmici di classe IV; 4 con diabete). Per trattarli sono stati effettuati 18 PSGB (5 con lidocaina, 5 con bupivacaina e 8 con lidocaina e bupivacaina; 16 con solo bolo, 2 con bolo seguito da infusione continua). Non si è verificata alcuna complicanza locale o sistemica. Il numero di recidive aritmiche si è ridotto significativamente dopo il PSGB sia a breve termine (unora post vs unora pre) sia a lungo termine (12 ore post vs 12 ore pre) (0 IQR 0-0 vs 3 IQR 1-10 p<0.001 and 1 IQR 0-2 vs 8 IQR 4-12 p =0.02 rispettivamente). Conclusioni: I nostri risultati confermano lefficacia e la sicurezza del blocco percutaneo del ganglio stellato di sinistra per il trattamento dello storm aritmico refrattario.
Blocco percutaneo del ganglio stellato di sinistra in pazienti con storm aritmico refrattario: i risultati della nostra esperienza intraospedaliera
FRACCHIA, ROSA
2018/2019
Abstract
Introduction. The treatment of electrical storm is a challenge and the standard treatments are often not enough to control arrhythmic relapses. The sympathetic system plays a pivotal role both in the genesis and in the maintenance of arrhythmias and the bilateral cardiac sympathetic denervation has been shown to be an effective treatment to prevent arrhythmias both in the case of channelopathies and in structural heart diseases. However, this technique is not suitable for an emergency situation but the percutaneous left stellate ganglion block (PSGB) seems to be a promising technique even if data from large series of cases are missing. Aim. We sought to assess the safety and the effectiveness of the percutaneous left stellate ganglion block in a series of patients with electrical storm admitted to Policlinico San Matteo. Material and methods. All the consecutive patients admitted to our institution presenting an electrical storm from November 2017 to August 2019 were enrolled in the study. Electrical storm was defined as the presence of three or more episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in 24 hours. PSGB was performed at the level of the left Chassaignac tubercle by injecting lidocaine or bupivacaine or both at discretion of the operator. The number of procedure related complications was counted and the numbers of DC shock or ATP pre and post procedure were compared with the Wilcoxon test for paired samples. Results. We enrolled 11 patients (age 70±13,4 years; 8 males; 4 with acute myocardial infarction, 1 with arrhythmogenic right ventricle dysplasia and 6 with chronic heart disease; mean ejection fraction 29.4%±14.2%; 6 in chronic therapy with Beta-blockers and 2 with class IV antiarrhythmic drugs; 4 with diabetes). For their treatment 18 PSGB were performed (5 with lidocaine; 5 with bupivacaine e 8 with lidocaine and bupivacaine; 16 as a single bolus and 2 with bolus and infusion). No local or systemic complications occurred. The number of arrhythmic relapses decreased significantly after the PSGB both in the short term (one hour after vs one hour before ) and in the long term (12 hours after vs 12 hours before) (0 IQR 0-0 vs 3 IQR 1-10 p<0.001 and 1 IQR 0-2 vs 8 IQR 4-12 p =0.02 respectively). Conclusions. Our results confirm the effectiveness and the safety of the percutaneous left stellate ganglion block for the treatment of refractory electric storm.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/25785