Stellate Ganglion Blockade for Refractory Ventricular Arrhythmias: Implications of ultrasound guided technique and review of the evidence

Abstract Refractory ventricular arrhythmias (VAs) carry high mortality rates despite electrical and pharmacological therapy utilization. These patients often require aggressive hemodynamic support including mechanical circulatory devices such as extracorporeal membrane oxygenation (ECMO) due to progressive hemodynamic and metabolic deterioration. Sympathetic nervous system stimulation and neuronal remodeling after myocardial insults have been implicated as drivers of refractory ventricular arrhythmias. This understanding has led to interest and a growing body of experience with percutaneous blockade of the stellate ganglion as a means of interrupting the vicious cycle of refractory VAs. A number of techniques have been described for stellate ganglion blockade (SGB) including landmark-driven approaches, fluoroscopy-assisted blockade, and ultrasound-guidance. Here, we evaluate the literature and describe our experience with SGB using ultrasound guidance for refractory VAs.