TY - JOUR
T1 - Safety and Efficacy of Ultrasound-Guided Sympathetic Blockade by Proximal Intercostal Block in Electrical Storm Patients
AU - Brigham Regional Anesthesia Group (BRAG)
AU - Batnyam, Uyanga
AU - Vlassakov, Kamen V.
AU - Halawa, Ahmad
AU - Seligson, Erica
AU - Zeballos, Jose
AU - O'Neill, Archana
AU - Flaherty, Devon
AU - Buckley, Carolyn
AU - Lirk, Philipp
AU - Chen, Yun Yun
AU - Steen, Talora
AU - Bains, Kavin
AU - Stone, Alexander
AU - Gerner, Philipp
AU - Desai, Amar
AU - Homsi, Joseph
AU - Chen, Liting
AU - Redouane, Brahim
AU - Janfaza, David
AU - Tedrow, Usha B.
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/4
Y1 - 2024/4
N2 - Background: Electrical storm (ES) patients who fail standard therapies have a high mortality rate. Previous studies report effective management of ES with bedside, ultrasound-guided percutaneous stellate ganglion block (SGB). We report our experience with sympathetic blockade administered via a novel alternative approach: proximal intercostal block (PICB). Compared with SGB, this technique targets an area typically free of other catheters and support devices, and may pose less strict requirements for anticoagulation interruption, along with lower risk of focal neurological side effects. Objectives: The authors sought to describe the safety and efficacy of PICB in patients with refractory ES. Methods: We reviewed our institutional data on ES patients who underwent PICB between January 2018 and February 2023 to analyze procedural safety and short- and long-term outcomes. Results: A total of 15 consecutive patients with ES underwent PICB during this period. Of those, 11 patients (73.3%) were maintained on PICB alone, and 4 patients (26.6%) were maintained on combined block with SGB and PICB. Overall, 72.7% patients who were maintained on PICB alone and 77.8% patients who were maintained on bilateral PICB had excellent arrhythmia suppression. After PICB, implantable cardioverter-defibrillator therapies were significantly reduced (P < 0.05), with 93.3% of patients receiving PICB having no implantable cardioverter-defibrillator shock until discharge or heart transplant. Anticoagulation was continued in all patients and there were no procedure-related complications. Apart from mild transient neurological symptoms seen in 3 patients, no significant neurological or hemodynamic sequelae were observed. Conclusions: In patients with refractory ES, continuous PICB provided safe and effective sympathetic block (77.8% ventricular arrhythmia suppression), achievable without interruption of anticoagulation, and without significant side effects.
AB - Background: Electrical storm (ES) patients who fail standard therapies have a high mortality rate. Previous studies report effective management of ES with bedside, ultrasound-guided percutaneous stellate ganglion block (SGB). We report our experience with sympathetic blockade administered via a novel alternative approach: proximal intercostal block (PICB). Compared with SGB, this technique targets an area typically free of other catheters and support devices, and may pose less strict requirements for anticoagulation interruption, along with lower risk of focal neurological side effects. Objectives: The authors sought to describe the safety and efficacy of PICB in patients with refractory ES. Methods: We reviewed our institutional data on ES patients who underwent PICB between January 2018 and February 2023 to analyze procedural safety and short- and long-term outcomes. Results: A total of 15 consecutive patients with ES underwent PICB during this period. Of those, 11 patients (73.3%) were maintained on PICB alone, and 4 patients (26.6%) were maintained on combined block with SGB and PICB. Overall, 72.7% patients who were maintained on PICB alone and 77.8% patients who were maintained on bilateral PICB had excellent arrhythmia suppression. After PICB, implantable cardioverter-defibrillator therapies were significantly reduced (P < 0.05), with 93.3% of patients receiving PICB having no implantable cardioverter-defibrillator shock until discharge or heart transplant. Anticoagulation was continued in all patients and there were no procedure-related complications. Apart from mild transient neurological symptoms seen in 3 patients, no significant neurological or hemodynamic sequelae were observed. Conclusions: In patients with refractory ES, continuous PICB provided safe and effective sympathetic block (77.8% ventricular arrhythmia suppression), achievable without interruption of anticoagulation, and without significant side effects.
KW - electrical storm
KW - proximal intercostal block
KW - stellate ganglion block
KW - ventricular fibrillation
KW - ventricular tachycardia
UR - https://www.scopus.com/pages/publications/85189870407
UR - https://www.scopus.com/inward/citedby.url?scp=85189870407&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2023.12.006
DO - 10.1016/j.jacep.2023.12.006
M3 - Article
C2 - 38300210
AN - SCOPUS:85189870407
SN - 2405-500X
VL - 10
SP - 734
EP - 746
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 4
ER -
