Stellate Ganglion Blockade in Electrical Storm: A Comprehensive Review

Electrical storm (ES), characterized by recurrent ventricular tachycardia or fibrillation refractory to conventional therapies, represents a critical medical emergency with substantial morbidity and mortality. The pathophysiological underpinnings of ES are intimately linked to heightened sympathetic tone and autonomic dysregulation, which perpetuate arrhythmogenesis. This extensive review synthesizes contemporary evidence on stellate ganglion blockade (SGB) as a neuromodulatory intervention for ES, examining its physiological rationale, procedural methodologies, and clinical outcomes. We integrate findings from pivotal studies, including institutional series and the recent large-scale prospective STAR study, to evaluate the safety profile and efficacy of both ultrasound-guided and anatomical landmark approaches. The analysis confirms that percutaneous SGB induces a rapid and significant reduction in arrhythmic burden, often serving as a crucial bridge to definitive therapy. Despite the absence of randomized controlled trials, the cumulative data from observational cohorts strongly support its integration into treatment algorithms for refractory ES, particularly in hemodynamically unstable patients where traditional options are limited or contraindicated. This review also addresses technical considerations, operator training, and future directions for research, emphasizing the need for standardized protocols and further investigation into long-term outcomes and patient selection criteria.