CT-guided left stellate ganglion cryoneurolysis for treatment of refractory ventricular arrhythmia

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Junman Kim, MD

Assistant Professor
Emory University School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Neil J. Resnick, MD

Interim Division Director of Interventional Radiology
Emory University
SM

Sivasai Manyapu, n/a

Student
Georgia Tech University
John David Prologo, MD

Division Director
Emory University School of Medicine

Disclosure(s):

Junman Kim, MD: No financial relationships to disclose

Neil J. Resnick, MD: No relevant disclosure to display

John David Prologo, MD: Focused Cryo: Board Membership (Ongoing), Ownership Interest (Ongoing)

Purpose: Ventricular tachycardia and fibrillation are life-threatening arrhythmias with an increasing prevalence. Interventional neural modulation of the cardiac sympathetic chain may suppress ventricular arrythmias in patients who fail conventional treatments, such as antiarrhythmic medications, implantable cardioverter-defibrillator and programming, and catheter ablation. Left stellate ganglion block is a well-established intervention for refractory ventricular arrhythmias. Compared with traditional blocks, cryoneurolysis has demonstrated longer-acting duration of efficacy. This study was conducted to evaluate the safety and feasibility of left stellate ganglion cryoneurolysis in the treatment of refractory ventricular arrythmias.

Materials and Methods: A retrospective chart review was performed. 12 patients with advanced heart failure complicated by refractory ventricular arrhythmias were referred from cardiology to interventional radiology for stellate ganglion blockade. Patients were 62 ± 9 years old and 83.3% (10/12) were males. All patients had persistent ventricular tachycardia or fibrillation despite optimized medical management, and none were current candidates for catheter ablation. 50% (6/12) had cardiac/pulmonary support device such as LVAD, IABP, Impella, or ECMO at the time of the procedure. In 25% (3/12) of cases, left stellate ganglion block using 0.25% bupivacaine was performed in a separate session preceding cryoneurolysis. All cryoneurolysis cases were performed using CT guidance to position a single IceSphere probe at the left T1 costovertebral junction. Freeze/thaw times were analyzed.

Results: Following cryoneurolysis, there was one procedure-related complication in a patient who experienced left upper extremity neuropraxia that improved within a month. 42% (5/12) of patients were bridged to subsequent catheter ablation. No further cardioversion/debrillation was required in 83% (10/12) of patients treated. Additional cardioversion/defibrillation episodes in remaining patients were significantly decreased postoperatively (38à9, 22à8). 75% (9/12) of patients are still alive with an average follow-up period of 9 ± 9.5 months. Remaining patients deceased during follow-up for reasons unrelated to the procedure.

Conclusion: Left stellate ganglion cryoneurolysis is feasible and safe. Further investigation of the efficacy, durability, and optimal treatment parameters is indicated. This treatment option may be considered for patients who have failed or do not qualify for traditional therapies.