早期使用经皮星状神经节阻滞治疗电风暴的疗效

Efficacy of early use of percutaneous stellate ganglion block for electrical storms.

作者信息

Baldi Enrico, Dusi Veronica, Rordorf Roberto, Currao Alessia, Compagnoni Sara, Sanzo Antonio, Gentile Francesca Romana, Frea Simone, Gravinese Carol, Angelini Filippo, Cauti Filippo Maria, Iannopollo Gianmarco, De Sensi Francesco, Gandolfi Edoardo, Frigerio Laura, Crea Pasquale, Zagari Domenico, Casula Matteo, Binaghi Giulio, Sangiorgi Giuseppe, Barone Lucy, Persampieri Simone, Dell'Era Gabriele, Patti Giuseppe, Colombo Claudia, Mugnai Giacomo, Tavella Domenico, Notaristefano Francesco, Barengo Alberto, Falcetti Roberta, Girardengo Giulia, D'Angelo Giuseppe, Tanese Nikita, Sgromo Vito, De Ferrari Gaetano Maria, Savastano Simone

机构信息

Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy.

Division of Cardiology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.

出版信息

Eur Heart J Acute Cardiovasc Care. 2024 Dec 3;13(11):757-765. doi: 10.1093/ehjacc/zuae109.

DOI:10.1093/ehjacc/zuae109

PMID:39317656

Abstract

AIMS

Electrical storm (ES) is a life-threatening condition requiring a rapid management. Percutaneous stellate ganglion block (PSGB) is proved to be safe and effective on top of standard therapy, but no data are available about its early use.

METHODS AND RESULTS

We considered all patients enrolled from 1 July 2017 to 30 April 2024 in the STAR registry (STellate ganglion block for Arrhythmic stoRm), a multicentre, international, observational, prospective registry. We aimed to assess the effectiveness of the first PSGB only. Patients were divided into two groups depending on whether they received PSGB before [early PSGB, often due to antiarrhythmic drug (AAD) contraindication] or after (delayed PSGB) intravenous AADs (AADs other than beta-blockers). We considered 180 PSGB (26 early PSGB and 154 AAD first). In the early PSGB group, we observed a statistically significant reduction of treated arrhythmic events in the hour after PSGB compared with the hour before: 0 (0-0) vs. 4.5 (1-10), P < 0.001, and the extent of the reduction was similar in the early PSGB and delayed PSGB groups [-4.5 (-7 to -2) vs. -2.5 (-3.5 to -1.5), P = ns]. The percentage of patients free from arrhythmias was similar in the two groups up to 12 h after PSGB (81 vs. 84%, P = 0.6, after 1 h; 77 vs. 79%, P = 0.8, at 3 h; and 65 vs. 69%, P = 0.7, after 12 h).

CONCLUSION

Percutaneous stellate ganglion block is proved to be effective also when used early in the treatment of ES. Due to its rapidity of action, our results may suggest its early use to reduce the number of defibrillations and possibly to reduce the likelihood of a refractory ES.

摘要

目的

电风暴（ES）是一种危及生命的状况，需要迅速处理。经皮星状神经节阻滞（PSGB）已被证明在标准治疗基础上是安全有效的，但关于其早期使用的数据尚不可得。

方法和结果

我们纳入了2017年7月1日至2024年4月30日在STAR注册研究（用于心律失常风暴的星状神经节阻滞）中登记的所有患者，这是一项多中心、国际性、观察性、前瞻性注册研究。我们仅旨在评估首次PSGB的有效性。根据患者在静脉使用抗心律失常药物（AAD，不包括β受体阻滞剂）之前[早期PSGB，通常由于抗心律失常药物禁忌]还是之后（延迟PSGB）接受PSGB，将患者分为两组。我们纳入了180例PSGB（26例早期PSGB和154例先使用AAD）。在早期PSGB组中，我们观察到与PSGB前一小时相比，PSGB后一小时治疗的心律失常事件有统计学意义的减少：0（0 - 0）对4.5（1 - 10），P < 0.001，早期PSGB组和延迟PSGB组的减少程度相似[-4.5（-7至-2）对-2.5（-3.5至-1.5），P = 无统计学差异]。在PSGB后长达12小时内，两组无心律失常患者的百分比相似（1小时后：81%对84%，P = 0.6；3小时时：77%对79%，P = 0.8；12小时后：65%对69%，P = 0.7）。