Iin-hospital Stellate Ganglion Block for Arrhythmic Storm

Arrhythmic storm is a real emergency and its treatment could be challenging. Antiarrhythmic drugs are few and often ineffective. Neuromodulation has been grown in evidences but no large multicentric studies are present in literature about safety and effectiveness of Percutaneous Stellate Ganglion Block (PSGB). Patients with an electrical storm refractory to at least one antiarrhythmic drug will receive PSGB and will be enrolled in the present study.The number of defibrillations before and after the treatment will be compared, complications will be annotated.

Inclusion Criteria:age ≥ 18 years,presence of arrhythmic storm defined as more than three sustained ventricular arrhythmias in 24 hours refractory to the standard medical treatment.Exclusion Criteria:A previous history of cardiac sympathicectomyHaving a neck judged unsuitable for the procedure (previous neck surgery, previous burns, presence of large scars, thyroid goiter)Both the two approaches present in literature and commonly used for this technique are allowed for the study:The "anatomical" approach which consist in the identification of the Chassaignac's tubercle that represents the point of needle insertionThe "echo-guided" approach Regardless to the approach (anatomical or echo-guided) the doctor will be able to choose, according to the clinical characteristics of the patients, whether to perform a single shot injection of anesthetic or a continuous infusion of anesthetic. In the second case a catheter will be left in place and connected to an infusion pump.