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@article{2300659,
author = {Jiravský, Otakar and Špaček, Radim and Chovančík, Jan and Neuwirth, Radek and Hudec, Miroslav and Škňouřil, Libor and Štěpánová, Radka and Suchackova, Paulina and Hecko, Jan and Fiala, Martin and Miklík, Roman},
article_location = {AMSTERDAM},
article_number = {September-October 2023},
doi = {http://dx.doi.org/10.1016/j.hjc.2023.04.003},
keywords = {Stellate ganglion blockade; Electrical storm; ICD therapy; Ventricular arrhythmia; Neuromodulation},
language = {eng},
issn = {1109-9666},
journal = {HELLENIC JOURNAL OF CARDIOLOGY},
title = {Early ganglion stellate blockade as part of two-step treatment algorithm suppresses electrical storm and need for intubation},
url = {https://www.sciencedirect.com/science/article/pii/S1109966623000593?via%3Dihub},
volume = {73},
year = {2023}
}
TY - JOUR
ID - 2300659
AU - Jiravský, Otakar - Špaček, Radim - Chovančík, Jan - Neuwirth, Radek - Hudec, Miroslav - Škňouřil, Libor - Štěpánová, Radka - Suchackova, Paulina - Hecko, Jan - Fiala, Martin - Miklík, Roman
PY - 2023
TI - Early ganglion stellate blockade as part of two-step treatment algorithm suppresses electrical storm and need for intubation
JF - HELLENIC JOURNAL OF CARDIOLOGY
VL - 73
IS - September-October 2023
SP - 24-35
EP - 24-35
PB - ELSEVIERRADARWEG
SN - 11099666
KW - Stellate ganglion blockade
KW - Electrical storm
KW - ICD therapy
KW - Ventricular arrhythmia
KW - Neuromodulation
UR - https://www.sciencedirect.com/science/article/pii/S1109966623000593?via%3Dihub
N2 - Background: For the treatment of patients with electrical storm (ES), we established a two-step algorithm comprising standard anti-arrhythmic measures and early ultrasound-guided stellate ganglion blockade (SGB). In this single-center study, we evaluated the short-term efficacy of the algorithm and tested the hypothesis that early SGB might prevent the need for intubations.Methods: Overall, we analyzed data for 70 ES events in 59 patients requiring SGB (mean age 67.7 +/- 12.4 years, 80% males, left ventricular ejection fraction 30.0% +/- 9.1%), all with implantable cardioverter-defibrillators (ICDs).Results: The mean time from ES onset to SGB was 13.2 +/- 12.3 hours. Percentage and mean absolute reduction in shocks at 48 hours after SGB reached 86.8% (-6.3 shocks), and anti-tachycardiac pacing (ATP) declined by 65.9% (-51.1 ATPs; all P < 0.001). Patients with the highest sustained ventricular arrhythmia (VA) burden (shocks >= 10/48 h; ATPs 10-99/48 h and >= 100/48 h) experienced the highest percentage decrease in ICD therapy (shocks -99.1%; ATPs-92.1% and -10 0.0%, respectively). For clinical response by defined criteria and two outcome periods (1/no sustained VA <= 48 hours post SGB, and 2/no ICD shock or <3 ATPs/day from day 3 to discharge/catheter ablation/day 8), 75.7% and 76.1% experienced complete response, respectively. Catecholamine support, no/low-dose beta-blocker therapy, polymorphic/ mixed-type VA, and baseline sinus rhythm versus atrial fibrillation were more frequent in patients with early arrhythmia recurrence. Temporary Horner's syndrome occurred in 67.1%, and no other adverse events were recorded. Intubation and general anesthesia during and after SGB were not needed.Conclusion: The presented two-step algorithm for treating ES proved efficacious and safe. The results support implementation of early SGB in routine ES management.(c) 2023 Hellenic Society of Cardiology.
ER -
JIRAVSKÝ, Otakar, Radim ŠPAČEK, Jan CHOVANČÍK, Radek NEUWIRTH, Miroslav HUDEC, Libor ŠKŇOUŘIL, Radka ŠTĚPÁNOVÁ, Paulina SUCHACKOVA, Jan HECKO, Martin FIALA and Roman MIKLÍK. Early ganglion stellate blockade as part of two-step treatment algorithm suppresses electrical storm and need for intubation. \textit{HELLENIC JOURNAL OF CARDIOLOGY}. AMSTERDAM: ELSEVIERRADARWEG, 2023, vol.~73, September-October 2023, p.~24-35. ISSN~1109-9666. Available from: https://dx.doi.org/10.1016/j.hjc.2023.04.003.
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