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.