Author + information
- Received September 23, 2019
- Revision received December 13, 2019
- Accepted December 27, 2019
- Published online February 26, 2020.
- Marat Fudim, MD, MHSa,b,∗ (, )
- Yawar J. Qadri, MD, PhDc,
- Nathan H. Waldron, MD, MHSc,
- Richard L. Boortz-Marx, MD, MSc,
- Arun Ganesh, MDc,
- Chetan B. Patel, MDa,
- Mihai V. Podgoreanu, MDc,
- Albert Y. Sun, MDa,
- Carmelo A. Milano, MDd,
- Betty C. Tong, MD, MHSd,
- David H. Harpole Jr., MDe,
- Joseph P. Mathew, MD, MHS, MBAc and
- Jonathan P. Piccini, MD, MHSa,b
- aDuke Cardiology, Duke University Medical Center, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cDuke Anesthesiology, Duke University School of Medicine, Durham, North Carolina
- dDivision of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
- eDuke Center for Atrial Fibrillation, Duke University Medical Center, Duke University, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Marat Fudim, Duke Cardiology, Duke Clinical Research Institute, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
Objectives This study sought to describe our institutional experience with establishing a neurocardiology service in an attempt to provide autonomic modulation as a treatment for ventricular arrhythmias (VAs).
Background Treatment-refractory VAs are commonly driven and exacerbated by heightened sympathetic tone.
Methods Among patients referred to the neurocardiology service (August 2016 to December 2018), we performed ultrasound-based, bilateral, temporary stellate ganglion blockade (SGB) in 20 consecutive patients. We analyzed outcomes of interest including sustained VA or VA requiring defibrillation in the 24 and 48 h before and 24 and 48 h after SGB.
Results The majority of patients were men (n = 19, 95%), with a mean age of 58 ± 14 years. At the time of SGB, 10 (50%) were on inotropic support and 9 (45%) were on mechanical circulatory support. Besides 1 case of hoarseness, there were no apparent procedural complications. SGB was associated with a reduction in the number of VA episodes from the 24 h before (median 5.5 [interquartile range (IQR): 2.0 to 15.8]) to 24 h after SGB (median 0 [IQR: 0 to 3.8]) (p < 0.001). The number of defibrillation events decreased from 2.5 (IQR: 0 to 10.3) to 0 (IQR: 0 to 2.5) (p = 0.002). Similar findings were observed over the 48-h period before and after the SGB. Overall, 9 of 20 (45%) patients had a complete response with no recurrence of ventricular tachycardia (VT) or ventricular fibrillation (VF) for 48 h after SGB. Four (20%) patients had no recurrent VT or VF following SGB through discharge. Similar response rates were observed in those with ischemic (median 6 [IQR: 1.8 to 18.8] to 0.5 [IQR: 0 to 5.3] events; p = 0.031) and nonischemic (median 3.5 [IQR: 1.8 to 6.8] to 0 [IQR: 0 to 1.3] events; p = 0.012) cardiomyopathy.
Conclusions Minimally invasive, ultrasound-guided bilateral SGB appears safe and provides substantial reduction in VA burden with approximately 1 in 2 patients exhibiting complete suppression of VT or VF for 48 h.
- autonomic modulation
- stellate ganglion block
- sympathetic tone
- ventricular fibrillation
- ventricular tachycardia storm
This work was supported by the Duke School of Medicine Interdisciplinary Colloquium. Dr. Fudim is supported by an American Heart Association grant (17MCPRP33460225) and a National Institutes of Health T32 grant (5T32HL007101). Dr. Qadri is supported by a National Institutes of Health T32 grant (GM08600) and Duke Health Fellows support. Dr. Waldron is supported by an American Heart Association grant (16MCPRP30700010). Dr. Fudim has served as a consultant for Coridea, Axon Therapies, and Galvani. Dr. Waldron has received grant support from and serves as a consultant to Allergan Inc. Dr. Boortz-Marx has served as consultant and on the advisory board for Medtronic, Dunn Pharmacy, Arbor Pharma; and on the board of directors of Pain Society of the Carolinas. Dr. Sun has served as a consultant for Biosense Webster, Merit Medical, and Medtronic. Dr. Tong has served as consultant and on the advisory board for Medtronic. Dr. Piccini has received grants for clinical research from Abbott, American Heart Association, Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, the National Heart, Lung, and Blood Institute, and Philips; and served as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, Johnson & Johnson, LivaNova, Medtronic, Milestone, Myokardia, Sanofi, Philips, and Up-to-Date. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 23, 2019.
- Revision received December 13, 2019.
- Accepted December 27, 2019.
- 2020 American College of Cardiology Foundation
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