Taming the Tachycardia: Stellate Ganglion Block for Treatment of Refractory Ventricular Arrhythmias

Introduction: Percutaneous stellate ganglionic block (SGB) using a local anesthetic is an emerging treatment for refractory ventricular arrhythmias (VA).


Methods: This retrospective cohort study included patients who underwent SGB with bupivacaine for refractory VA in the cardiac or cardiothoracic intensive care units from 1/1/2021 to 7/1/2025. The primary outcome was the incidence of short-term success of SGB, defined as a composite reduction of VA therapies in the 48 hours after SGB. This included a reduction in the number of defibrillations, compared to the prior 48 hours, de-escalation of antiarrhythmic drugs (AAD), or a reduction in the number of sedative agents. Data on VA interventions and adverse events were collected for 48 hours post-SGB or until death.


Results: Our cohort included 11 SGB administered in 9 patients with a median age of 69 (IQR 65,70) years, with ischemic cardiomyopathy as the cause of refractory VA in 5/9 patients. The median time from hospital admission to SGB was 10 days (IQR 7,15). Bupivacaine HCl was used in 8 (73%) SGBs, and liposomal bupivacaine in 3 (27%) SGBs. At the time of SGB, 7/9 patients were on mechanical circulatory support and 7/9 patients were on vasopressors. The incidence of short-term success was observed in 6/9 patients, with one patient requiring subsequent SGB administration. Of these 6 patients, 2 met more than one definition of the composite primary endpoint, with the remaining 4 meeting a single outcome criterion. AAD de-escalation was the most frequently achieved endpoint, occurring in 3/9 patients. Shock reduction occurred in 3/9 patients and a decrease in sedatives occurred in 3/9 patients. Mild adverse events occurred in 5/9 patients, with 1 patient experiencing Horner’s syndrome and hoarseness twice after repeat administrations. The remaining 4 patients experienced Horner’s syndrome. No fatal or serious adverse events occurred. SGB bridged two patients to heart transplants and two patients to ICD implantations. Recurrent VA occurred within 48 hours of SGB in 6/9 patients. In-hospital mortality was 56% (5/9) for the cohort.


Conclusions: SGB remains an emerging treatment for refractory VA. Further data is needed to delineate appropriate patient selection, timing of SGB, and optimal selection of local anesthetic formulation.