Early ganglion stellate blockade as part of two-step treatment
algorithm suppresses electrical storm and need for intubation

J 2023

Early ganglion stellate blockade as part of two-step treatment algorithm suppresses electrical storm and need for intubation

JIRAVSKÝ, Otakar, Radim ŠPAČEK, Jan CHOVANČÍK, Radek NEUWIRTH, Miroslav HUDEC et. al.

Basic information

Original name

Early ganglion stellate blockade as part of two-step treatment algorithm suppresses electrical storm and need for intubation

Authors

JIRAVSKÝ, Otakar (203 Czech Republic, belonging to the institution), Radim ŠPAČEK (203 Czech Republic), Jan CHOVANČÍK (203 Czech Republic), Radek NEUWIRTH (203 Czech Republic, belonging to the institution), Miroslav HUDEC (203 Czech Republic, belonging to the institution), Libor ŠKŇOUŘIL (203 Czech Republic), Radka ŠTĚPÁNOVÁ (203 Czech Republic, belonging to the institution), Paulina SUCHACKOVA, Jan HECKO (203 Czech Republic), Martin FIALA (203 Czech Republic, belonging to the institution) and Roman MIKLÍK (203 Czech Republic, guarantor)

Edition

HELLENIC JOURNAL OF CARDIOLOGY, AMSTERDAM, ELSEVIERRADARWEG, 2023, 1109-9666

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

Netherlands

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.100 in 2022

RIV identification code

RIV/00216224:14110/23:00131355

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.hjc.2023.04.003

UT WoS

001083682800001

Keywords in English

Stellate ganglion blockade; Electrical storm; ICD therapy; Ventricular arrhythmia; Neuromodulation

Abstract

V originále

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.

Links

CZ.02.1.01/0.0/0.0/16_013/0001826, interní kód MU
(CEP code: EF16_013/0001826)

Name: CZECRIN_PRO PACIENTY - zavádění inovativních moderních terapií

Investor: Ministry of Education, Youth and Sports of the CR, Priority axis 1: Strengthening capacities for high-quality research

90249, large research infrastructures

Name: CZECRIN IV

Citovat

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. 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.

@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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