Breakthrough Treatment Offers Hope for Electrical Storm Patients

In a groundbreaking effort to address the clinical emergency posed by electrical storms (ES) and the scarcity of effective treatments, researchers have unveiled compelling findings from the STAR study, a multicenter observational investigation. The study focused on the potential efficacy and safety of percutaneous stellate ganglion block (PSGB) as a novel intervention for ES, refractory to standard treatments. The results, spanning the period from July 1, 2017, to June 30, 2023, present a ray of hope for patients grappling with this challenging condition.

The study results were published in the European Heart Journal.

Electrical storms, characterized by three or more episodes of ventricular arrhythmias or ventricular fibrillation (VF), represent a critical clinical scenario with limited established therapeutic options. Initial reports on PSGB hinted at its safety and effectiveness, but questions lingered, prompting the need for a comprehensive study. The STAR study aimed to fill this void, shedding light on the potential of PSGB as a viable intervention for ES.

Conducted as a multicenter observational study, STAR enrolled 131 patients from 19 centers, all experiencing ES refractory to standard treatments. The primary focus was on assessing the reduction of treated arrhythmic events by at least 50%, comparing the 12 hours following PSGB with the 12 hours preceding the procedure. Operators underwent specialized training for both the anterior anatomical and lateral ultrasound-guided approaches.

Key Findings:

• The results of the STAR study are nothing short of promising.
• Among the 184 PSGB procedures conducted, 92% of patients achieved the primary outcome, showcasing a significant reduction in arrhythmic events.
• The median reduction of arrhythmic episodes between 12 hours before and after PSGB was an impressive 100%, underscoring the potential efficacy of this intervention.
• Importantly, arrhythmic episodes requiring treatment exhibited a noteworthy decline, with a statistically significant difference observed between the 12 hours before the first PSGB and the 12 hours after the last procedure.
• The reduction continued when comparing 1 hour before and 1 hour after each procedure, emphasizing the sustained impact of PSGB.
• Moreover, the study reported a low incidence rate of one major complication, emphasizing the safety profile of the intervention.

The STAR study marks a significant stride in the pursuit of effective treatments for electrical storms. The compelling evidence supporting the effectiveness and safety of PSGB in treating refractory ES offers newfound hope for patients and clinicians alike. These findings pave the way for further exploration and potential incorporation of PSGB into the standard armamentarium for managing this complex clinical emergency.

Further reading: Savastano S, Baldi E, Compagnoni S, et al. Electrical storm treatment by percutaneous stellate ganglion block: the STAR study. Eur Heart J. Published online January 30, 2024. doi:10.1093/eurheartj/ehae021