Il blocco percutaneo del ganglio stellato: la tecnica che sta cambiando la gestione della tempesta aritmica

Electrical storm represents a significant challenge in the management of cardiological emergencies, with a high mortality rate. The therapeutic armamentarium is limited, and the efficacy of available drugs is not always consistent. Furthermore, non-pharmacological strategies are restricted in their application and not universally accessible in medical facilities. There is a close link between the autonomic nervous system and ventricular arrhythmias, as the activation of the sympathetic nervous system can modify the electrophysiological characteristics of the substrate and increase triggered activity and automaticity. This combination is crucial for the initiation and maintenance of ventricular arrhythmias. In recent years, percutaneous stellate ganglion block has emerged as an option in the management of electrical storm, a development largely informed by the findings of multicenter studies that have substantiated its efficacy and safety, along with its expeditious learning curve, thereby paving the way for its widespread adoption. Nevertheless, the role of stellate ganglion block within clinical guidelines remains circumscribed, primarily due to the paucity of data from randomized studies. Its indication is reserved for when alternative therapeutic strategies, both pharmacological and non-pharmacological, have failed to yield the desired outcomes. In the future, it may well be used earlier in the treatment of arrhythmic storm, helping to avoid arrhythmia refractoriness and an unfavorable outcome.