Percutaneous Stellate Ganglion Block for Electrical Storm

Electrical storm presents a challenging cardiological emergency with limited treatment options. Pharmacological interventions are often ineffective, while non-pharmacological treatments requiring specialized skills or equipment may not be readily available. Physicians face the daunting task of stabilizing critically ill patients with recurrent ventricular arrhythmias, often with high mortality rates. Transporting patients to specialized centres for advanced treatments like transcatheter ablation or circulatory support may be necessary. Percutaneous stellate ganglion block emerges as a crucial intervention in this context. Originally developed for pain management, its antiarrhythmic potential became evident in the 1970s with the understanding of the autonomic nervous system's role in arrhythmogenesis. This manual aims to provide insights into the rationale, efficacy, safety, and execution technique of stellate ganglion block, offering a valuable addition to the therapeutic armamentarium for arrhythmic storm. It covers various aspects from ventricular arrhythmia pathophysiology to modern treatment approaches and the influence of the autonomic nervous system. The text reviews literature supporting the technique's antiarrhythmic efficacy and provides detailed guidance on its execution using anatomical landmarks and imaging.

Ventricular Arrhythmias.- The Ventricular electrical storm.- The autonomic nervous system and ventricular arrhythmias.- The rationale for the percutaneous stellate ganglion block.- PSGB: Safety and Effectiveness .- Anatomy of the neck.- Anterior approach using anatomical landmarks.- Lateral ultrasound-guided approach.- Pharmacology of local anaesthetics.- Complications and their management.

Dr. Savastano graduated in Medicine in 2004 with top honors, focusing his thesis on echocardiography's role in stratifying the risk of death in cardiac amyloidosis patients. Subsequently, he completed his Cardiology degree in 2008 with outstanding grades, researching inflammatory markers' predictive value for cardiac resynchronization therapy response. Joining the Fondazione IRCCS Policlinico San Matteo in 2009 as a Cardiology consultant, he initiated and leads the Pavia Cardiac Arrest Registry (PaviaCARe), now Lombardia CARe since 2019. He heads the RESTART research group on cardiac arrest and resuscitation, officially recognized by Fondazione IRCCS San Matteo in 2023. Serving as adjunct professor of Cardiology at the University of Pavia since 2022, he contributes to ESCAPE-NET and action PARQ, EU-funded European initiatives for sudden cardiac arrest prevention and care quality improvement.

His involvement in percutaneous stellate ganglion block (PSGB) began in 2017 at Fondazione IRCCS Policlinico San Matteo, leading to its widespread adoption. Notable publications and courses established San Matteo as a leading centre for PSGB in Italy. This culminated in the STAR Study, the largest multicentre observational study on PSGB for recurrent ventricular arrhythmias, and the LIVE study, exploring SGB for out-of-hospital cardiac arrest. Over time, PSGB became a hallmark procedure at San Matteo, reflecting its excellence in cardiac care.