Baldi Enrico, Rordorf Roberto, Compagnoni Sara, Dusi Veronica, Sanzo Antonio, Gentile Francesca Romana, Frea Simone, Gravinese Carol, Cauti Filippo Maria, Iannopollo Gianmarco, De Sensi Francesco, Gandolfi Edoardo, Frigerio Laura, Crea Pasquale, Zagari Domenico, Casula Matteo, Sangiorgi Giuseppe, Persampieri Simone, Dell'Era Gabriele, Patti Giuseppe, Colombo Claudia, Mugnai Giacomo, Notaristefano Francesco, Barengo Alberto, Falcetti Roberta, Girardengo Giulia, D'Angelo Giuseppe, Tanese Nikita, Currao Alessia, Sgromo Vito, De Ferrari Gaetano Maria, Savastano Simone
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Heart Rhythm. 2024 Nov 15. doi: 10.1016/j.hrthm.2024.11.015.
Data on the predictors of percutaneous stellate ganglion block (PSGB) efficacy in electrical storm are scanty.
We aimed to assess whether PSGB efficacy is influenced by the arrhythmia type and cycle length before the procedure.
This is a subanalysis of the multicenter STAR study. The population was stratified into 3 groups according to the median cycle length of the latest ventricular arrhythmia before PSGB: ventricular fibrillation (VF), fast ventricular tachycardia (VT), and slow VT. The primary outcome was the number of treated arrhythmic episodes (with antitachycardia pacing or direct current shocks) in the hour immediately after PSGB compared with the hour before.
We considered 139 PSGBs from 112 patients divided into VF (51 procedures), fast VT (44 procedures, VT cycle <375 ms), and slow VT (44 procedures, VT cycle ≥375 ms). The number of treated arrhythmic episodes in the hour after every PSGB was significantly lower compared with the hour before in all groups (VF: 0 [0-1] vs 5 [2-8], P < .001; fast VT: 0 [0-0] vs 1 [0-6.5], P < .001; slow VT: 0 [0-0] vs 1 [0-4.5], P = .001). In analyzing the reduction of the number of antitachycardia pacing sequences or direct current shocks from the hour before to the hour after PSGB, a significant trend was observed across the groups (Jonckheere-Terpstra trend P < .001), and a significant difference was observed in comparing slow VT vs VF and fast VT vs VF but not in comparing slow VT vs fast VT. VF was independently associated with the probability of reduction of treated events after PSGB.
PSGB is an effective treatment of electrical storm in patients with all types of ventricular arrhythmias. However, its effectiveness was more pronounced in patients with VF.
关于电风暴中经皮星状神经节阻滞（PSGB）疗效预测因素的数据较少。
我们旨在评估PSGB疗效是否受术前心律失常类型和周期长度的影响。
这是一项多中心STAR研究的亚分析。根据PSGB前最新室性心律失常的中位周期长度，将研究人群分为3组：心室颤动（VF）、快速室性心动过速（VT）和缓慢VT。主要结局是PSGB后即刻1小时内与术前1小时相比，经治疗的心律失常发作次数（采用抗心动过速起搏或直流电电击）。
我们纳入了112例患者的139次PSGB，分为VF组（51例）、快速VT组（44例，VT周期<375毫秒）和缓慢VT组（44例，VT周期≥375毫秒）。所有组中，每次PSGB后1小时内经治疗的心律失常发作次数均显著低于术前1小时（VF组：0[0 - 1]对5[2 - 8]，P <.001；快速VT组：0[0 - 0]对1[0 - 6.5]，P <.001；缓慢VT组：0[0 - 0]对1[0 - 4.5]，P =.001）。在分析PSGB前1小时至后1小时抗心动过速起搏序列或直流电电击次数的减少情况时，各组间观察到显著趋势（Jonckheere - Terpstra趋势P <.001），比较缓慢VT与VF以及快速VT与VF时有显著差异，但比较缓慢VT与快速VT时无显著差异。VF与PSGB后治疗事件减少的可能性独立相关。
PSGB是治疗各类室性心律失常患者电风暴的有效方法。然而，其有效性在VF患者中更为显著。
