Efficacy and safety of percutaneous stellate ganglion block technique in patients with electrical storm complicated by cardiogenic shock
S Pontremoli, A Morena, A Currao, M Paggi, E Baldi, G Boggian, M Casula, R Pittorru, A Paoletti Perini, V Carinci, E Gandolfi, T Sanna, S Compagnoni, G Mugnai, S SavastanoAbstract
Introduction
Electrical storm (ES) is often associated with cardiogenic shock thus making a deadly combination sustained by a self-perpetuating vicious cycle of hemodynamic deterioration resulting in a sympathetic hyperactivity. Percutaneous left stellate ganglion block (PSGB) is an emerging autonomic neuromodulation strategy helpful for refractory ES. However, its use remains limited because of its feared negative effects of sympathetic blockade on hemodynamics.
Purpose
To evaluate the impact of PSGB on cardiac function, hemodynamic profile, and clinical outcomes in patients with ES and cardiogenic shock. The primary endpoint was the impact of PSGB on hemodynamic status (SCAI shock classification1 and lactate levels) and biventricular function. Secondary endpoints included antiarrhythmic efficacy—defined as reduction in arrhythmic burden in the 12 hours after PSGB compared with the preceding 12 hours—and the association between SCAI class and in-hospital mortality.
Methods
We performed a multicenter retrospective and prospective study including centers participating in the STAR study2. A total of 115 PSGB procedures, performed between July 2017 and September 2025 in patients with ES and cardiogenic shock were analyzed. Standard measures of left and right ventricular function were analyzed, SCAI classification was used to grade cardiogenic shock severity. Standard descriptive statistics and logistic regression models were used.
Results
Within 24 hours after PSGB, the proportion of patients in advanced shock (SCAI ≥C) significantly decreased (47.8% vs. 29.2%, p<0.001), along with median lactate levels (2.02 vs. 1.03 mmol/L, p<0.001). Left ventricular ejection fraction improved from 30% at PSGB to 35% at discharge (p<0.0001), and right ventricular fractional area change increased from 40% to 42% (p=0.02). An improving trend was observed at 24 hours, although not statistically significant. SCAI class independently predicted in-hospital mortality both at the time of PSGB (C: OR 6.09, p=0.0346; D: OR 17.12, p=0.001; E: OR 15.03, p=0.001) and at 24 hours (C: OR 6.71, p=0.025; D: OR 18.85, p<0.001; E: OR 66.72, p<0.001). PSGB significantly reduced the number of treated arrhythmic events (median 3 [1–7] vs. 0 [0–1] in the 12 hours before vs. after PSGB, p<0.001), with effect evident at 1 hour (1 [0–4] vs. 0 [0–0], p<0.001). Notably, greater arrhythmia reduction was associated with a lower probability of severe CS at 24 hours, with each shock avoided reducing the likelihood of SCAI C–D–E by 3% (OR 0.97 [0.94–0.99], p=0.03).
Conclusions
PSGB is safe and effective in suppressing ventricular arrhythmias irrespective of baseline hemodynamic status. The reduction of the number defibrillation was also associated with improved biventricular function and hemodynamic stabilization, suggesting a potential positive role of PSGB on survival of patients with ES complicated by cardiogenic shock.