Electrical storm treatment by percutaneous stellate ganglion block: the STAR study
Simone Savastano, Enrico Baldi, Sara Compagnoni, Roberto Rordorf, Antonio Sanzo, Francesca Romana Gentile, Veronica Dusi, Simone Frea, Carol Gravinese, Filippo Maria Cauti, Gianmarco Iannopollo, Francesco De Sensi, Edoardo Gandolfi, Laura Frigerio, Pasquale Crea, Domenico Zagari, Matteo Casula, Giuseppe Sangiorgi, Simone Persampieri, Gabriele Dell’Era, Giuseppe Patti, Claudia Colombo, Giacomo Mugnai, Francesco Notaristefano, Alberto Barengo, Roberta Falcetti, Giovanni Battista Perego, Giuseppe D’Angelo, Nikita Tanese, Alessia Currao, Vito Sgromo, Gaetano Maria De Ferrari, Alessandro Fasolino, Sara Bendotti, Roberto Primi, Angelo Auricchio, Giulio Conte, Pietro Rossi, Filippo Angelini, Arianna Morena, Antonio Toscano, Valeria Carinci, Giuseppe Dattilo, Nastasia Mancini, Marco Corda, Gianfranco Tola, Giulio Binaghi, Claudia Scudu, Lucy Barone, Alessandro Lupi, Claudia Carassia, Federica De Vecchi, Sara Vargiu,- Cardiology and Cardiovascular Medicine
Abstract
Background and Aims
An electrical storm (ES) is a clinical emergency with a paucity of established treatment options. Despite initial encouraging reports about the safety and effectiveness of percutaneous stellate ganglion block (PSGB), many questions remained unsettled and evidence from a prospective multicentre study was still lacking. For these purposes, the STAR study was designed.
Methods
This is a multicentre observational study enrolling patients suffering from an ES refractory to standard treatment from 1 July 2017 to 30 June 2023. The primary outcome was the reduction of treated arrhythmic events by at least 50% comparing the 12 h following PSGB with the 12 h before the procedure. STAR operators were specifically trained to both the anterior anatomical and the lateral ultrasound-guided approach.
Results
A total of 131 patients from 19 centres were enrolled and underwent 184 PSGBs. Patients were mainly male (83.2%) with a median age of 68 (63.8–69.2) years and a depressed left ventricular ejection fraction (25.0 ± 12.3%). The primary outcome was reached in 92% of patients, and the median reduction of arrhythmic episodes between 12 h before and after PSGB was 100% (interquartile range −100% to −92.3%). Arrhythmic episodes requiring treatment were significantly reduced comparing 12 h before the first PSGB with 12 h after the last procedure [six (3–15.8) vs. 0 (0–1), P < .0001] and comparing 1 h before with 1 h after each procedure [2 (0–6) vs. 0 (0–0), P < .001]. One major complication occurred (0.5%).
Conclusions
The findings of this large, prospective, multicentre study provide evidence in favour of the effectiveness and safety of PSGB for the treatment of refractory ES.