Stellate ganglion block as a palliative care management strategy in patients with terminal cardiac arrhythmias: a case series

Abstract

Introduction: Palliative care in patients with cardiovascular diseases such as refractory cardiac arrhythmias involve a series of actions different from those we are usually familiar with in cancer patients. Interventionism stands out and can have a great impact on the control of the patient’s symptoms. Electrical storm is associated with a high symptom burden and an increased risk of sudden death due to stroke, and its treatment can become a challenge in refractoriness to conventional treatment. Stellate ganglion block is a minimally invasive procedure that has been shown to be effective for the control of electrical storm in case of refractoriness to pharmacological treatment or as a bridge therapy to arrhythmic substrate ablation. Objective: To describe the effectiveness of stellate ganglion block in patients with terminal cardiac arrhythmias, reporting arrhythmia control (measured by device discharges) and symptom control, in patients attended at a cardiovascular center of excellence. Material and Methods: Observational case series study. The search was performed in the logbook of the Pain and Palliative Care Service in a Hospital. Patients over 18 years of age, of either sex, with a diagnosis of electrical storm, with implantable cardioverter defibrillator, without contraindications for the administration of lidocaine, bupivacaine or dexamethasone, who had the cognitive ability to rate their symptoms on an analogous numerical scale and who had been attended between January 2021 and June 2022 were included. Results: Data was recorded for 15 patients with electrical storm who underwent stellate ganglion block. Eighty-seven point five percent of patients had an improvement in dyspnea greater than 50%, 62.5% in palpitation sensation, and 75% in pain vs. the initial numerical analogue scale punctuation. The average number of implantable cardioverter defibrillator shocks before the procedure was 8.8 shocks in total, post-procedure was 0.2 shocks. Post-procedure electrical storm recurrence was 40% with a mean of 7.6 weeks between the procedure and the new event. Conclusion: In this case series, stellate ganglion block is shown to be an option for the management of refractory cardiac arrhythmias in patients with implantable cardioverter defibrillators, reducing the number of device shocks and the management of symptoms such as pain, palpitations and dyspnea. © 2024 Sociedad de Anestesiologia de Chile. All rights reserved.