Introduction Percutaneous stellate ganglion block (PSGB) is gaining traction for the treatment of patients with electrical storm. Recent studies have confirmed its efficacy and safety, however, given the several pharmacological properties, there is a lack of evidence on how different local anaesthetics (LAs) may influence its efficacy. Materials and methods We considered the PSGBs performed from 1/Jul/2017 to 30/Apr/2024 at the 19 italian Centres of the STAR group. The number of arrhythmias treated with shock (internal or external) or with antitachycardia pacing (ATP) one hour before and one hour after each procedure was compared, both those performed with a single anaesthetic and those performed with a combination of anaesthetics. Logistic regression models were used to test the association between the number of anaesthetics used and the probability of complete suppression of arrhythmias in the hour following the procedure. Results We considered 254 PSGBs: 77 (30%) performed with a single anaesthetic (65 lidocaine, 8 bupivacaine, 3 mepivacaine and 1 ropivacaine) and 174 (68%) with the combination of two anaesthetics (68 lidocaine+bupivacaine, 94 lidocaine+ropivacaine and 12 lidocaine+mepivacaine), in 3 cases the anaesthetic was unknown. With both one anaesthetic and two in combination, a significant reduction in treated arrhythmias was documented in the first hour after the block (Figure 1). The percentage of procedures followed by complete suppression of treated arrhythmias in the first hour after the procedure was significantly higher when a combinations of anaesthetics was used (91% vs. 66%, p<0.01). However, the extent of arrhythmia reduction at one hour was similar when comparing different pairs of anaesthetics (Figure 2). On multivariate analysis, adjusted for tachycardia cycle, number of intravenous antiarrhythmic drugs used and number of arrhythmias treated in the previous hour, the use of two anaesthetic drugs was significantly associated with the probability of having complete suppression of arrhythmias in the following hour [OR 4.3 (1.6-11.1), p<0.01]. Conclusions PSGB reduced the number of treated arrhythmias both when performed with two LAs and with a single LA. However, although there were no differences between the drug pairs administered, the use of two anaesthetics was independently associated with the probability of having complete suppression of arrhythmias in the first hour after the procedure.
Associazione Nazionale Medici Cardiologi Ospedalieri
