Taming ventricular tachycardia: experience of stellate ganglion ablation across the spectrum of ventricular arrhythmias, a safe and effective intervention beyond the electrical storm

Ventricular arrhythmias (VAs) are complex, recurrent and life-threatening events arising from diverse cardiopathies, with a broad spectrum of presentations. Effective treatment presents significant challenges and often necessitates a multimodal approach. Although stellate ganglion ablation (SGA) has emerged as a promising therapy, manily in electric storm —as acknowledged in current guidelines—, it remains positioned at a lower tier within clinical algorithms, and existing evidence is limited.

Our study seeks to enhance the understanding of SGA by investigating its potential role across a wider spectrum of VAs, beyond the confines of electrical storm. We aim to report our centre's experience, encompassing diverse aetiologies and presentations, intending to illustrate the potential benefits, procedural outcomes, safety, and follow-up results associated we have observed so far.

We conducted a case series analysis of nine patients treated in our centre from April 2023 to October 2024. Baseline characteristics included underlying cardiopathy, imaging features, and previous VA events and therapies. For the VAs prompting SGA performance, morphology, haemodynamic impact, and management were assessed, as well technical aspects of the SGA procedure (ultrasound-guided, non-emergent, with a combination of radiofrequency and local lidocaine). Descriptive statistics were applied to summarise the data, with central tendency and dispersion measures for continuous variables and frequency distributions for categorical data. Post-procedural follow-up employed also a descriptive approach, examining arrhythmic recurrence and its implications.

Following SGA, eight patients (89 %) experienced a significant reduction in arrhythmic burden and ICD therapies, with only one readmitted due to VA recurrence and another one receiving a single ICD shock in the setting of kidney artery embolism. In one patient (11 %), the technique was repeated, but for the management of supraventricular tachycardia and ventricular extrasystoles. Three patients underwent subsequent VT ablation (33 %), a more complex and less avaiable procedure, though only one exhibited notable additional benefits. Furthermore, de-escalation of AAD was achieved in two patients (22 %). Considering the notable β-blocking effect, left ventricle ejection fraction evolution was assessed, with no significant improvement detected. Importantly, no procedural complications were reported.

SGA may provide a safe and effective strategy for managing VAs, within a diverse array of arrhythmias and patients. These findings position SGA as a valuable adjunctive therapy, potentially enhancing survival and quality of life, regardless of whether it ocurrs in the form of electrical storm or not. We will continue to recruit patients and extend follow-up in our work, while acknowledging that further large-scale studies are necessary to elucidate these outcomes.

Baseline characteristics