Stellate Ganglion Blockade for the Treatment of Refractory Ventricular Arrhythmias
Stellate Ganglion Blockade for the Treatment of Refractory Ventricular Arrhythmias
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DOI：
10.1016/j.jacep.2019.12.017
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发表时间：
2020-05-01
影响因子：
7
通讯作者：
Piccini, Jonathan P.
中科院分区：
文献类型：
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作者：
Fudim, Marat;Qadri, Yawar J.;Piccini, Jonathan P.
目的 本研究旨在描述我们建立神经心脏病学服务的机构经验，试图提供自主调节作为室性心律失常 (VAS) 的治疗方法。 背景 难治性 VAs 通常由交感神经张力增高驱动和加剧。 方法 在转诊至神经心脏病学服务的患者中（2016 年 8 月至 2018 年 12 月），我们进行了对连续 20 名患者进行基于超声的双侧临时星状神经节阻滞 (SGB)。我们分析了感兴趣的结果，包括 SGB 前 24 和 48 小时以及术后 24 和 48 小时内持续 VA 或需要除颤的 VA。 结果 大多数患者为男性 (n = 19, 95%)，平均年龄为 58 +/- 14 岁。在 SGB 时，10 名（50%）接受正性肌力支持，9 名（45%）接受机械呼吸支持。除1例声音嘶哑外，无明显手术并发症。 SGB 与 VA 发作次数减少相关，从前 24 小时（中位数 5.5 [四分位距 (IQR)：2.0 至 15.8]）到 SGB 后 24 小时（中位数 0 [IQR：0 至 3.8]）（p < 0.001）。除颤事件的数量从 2.5 次（IQR：0 至 10.3）减少至 0 次（IQR：0 至 2.5）（p = 0.002）。在 SGB 前后 48 小时内观察到类似的结果。总体而言，20 名患者中有 9 名 (45%) 获得完全缓解，SGB 后 48 小时内没有室性心动过速 (VT) 或心室颤动 (VF) 复发。四名 (20%) 患者在 SGB 出院后未出现复发性 VT 或 VF。在缺血性事件（中位数 6 [IQR：1.8 至 18.8] 至 0.5 [IQR：0 至 5.3] 事件；p = 0.031）和非缺血性事件（中位数 3.5 [IQR：1.8 至 6.8] 至 0 [IQR：0 至 1.3] 事件；p = 0.012）的患者中观察到类似的反应率。结论 微创、超声引导下的双侧 SGB 似乎是安全的，并且可以显着减轻 VA 负担，大约二分之一的患者表现出 VT 或 VF 完全抑制达 48 小时。 (C) 2020 年，美国心脏病学会基金会。
OBJECTIVES This study sought to describe our institutional experience with establishing a neurocardiotogy service in an attempt to provide autonomic modulation as a treatment for ventricular arrhythmias (VAS).BACKGROUND Treatment-refractory VAs are commonly driven and exacerbated by heightened sympathetic tone.METHODS Among patients referred to the neurocardiotogy service (August 2016 to December 2018), we performed ultrasound-based, bilateral, temporary stellate ganglion blockade (SGB) in 20 consecutive patients. We analyzed outcomes of interest including sustained VA or VA requiring defibrillation in the 24 and 48 h before and 24 and 48 h after SGB.RESULTS The majority of patients were men (n = 19, 95%), with a mean age of 58 +/- 14 years. At the time of SGB, 10 (50%) were on inotropic support and 9 (45%) were on mechanical drculatory support. Besides 1 case of hoarseness, there were no apparent procedural complications. SGB was associated with a reduction in the number of VA episodes from the 24 h before (median 5.5 [interquartile range (IQR): 2.0 to 15.8]) to 24 h after SGB (median 0 [IQR: 0 to 3.8]) (p < 0.001). The number of defibrillation events decreased from 2.5 (IQR: 0 to 10.3) to 0 (IQR: 0 to 2.5) (p = 0.002). Similar findings were observed over the 48-h period before and after the SGB. Overall, 9 of 20 (45%) patients had a complete response with no recurrence of ventricular tachycardia (VT) or ventricular fibrillation (VF) for 48 h after SGB. Four (20%) patients had no recurrent VT or VF following SGB through discharge. Similar response rates were observed in those with ischemic (median 6 [IQR: 1.8 to 18.8] to 0.5 [IQR: 0 to 5.3] events; p = 0.031) and nonisdiemic (median 3.5 [IQR: 1.8 to 6.8] to 0 [IQR: 0 to 1.3] events; p = 0.012) cardiomyopathy.CONCLUSIONS Minimally invasive, ultrasound-guided bilateral SGB appears safe and provides substantial reduction in VA burden with approximately 1 in 2 patients exhibiting complete suppression of VT or VF for 48 h. (C) 2020 by the American College of Cardiology Foundation.