EFFICACY OF PERCUTANEOUS STELLATE GANGLION BLOCK IN PATIENTS WITH ARRHYTHMIC STORM: WHICH ROLE DO ANAESTHETICS PLAY? DATA FROM A MULTICENTRE CASE STUDY
Bibliographic record
Abstract
Abstract Introduction Percutaneous stellate ganglion block (PSGB) is gaining traction for the treatment of patients with electrical storm. Recent studies have confirmed its efficacy and safety, however, given the several pharmacological properties, there is a lack of evidence on how different local anaesthetics (LAs) may influence its efficacy. Materials and methods We considered the PSGBs performed from 1/Jul/2017 to 30/Apr/2024 at the 19 italian Centres of the STAR group. The number of arrhythmias treated with shock (internal or external) or with antitachycardia pacing (ATP) one hour before and one hour after each procedure was compared, both those performed with a single anaesthetic and those performed with a combination of anaesthetics. Logistic regression models were used to test the association between the number of anaesthetics used and the probability of complete suppression of arrhythmias in the hour following the procedure. Results We considered 254 PSGBs: 77 (30%) performed with a single anaesthetic (65 lidocaine, 8 bupivacaine, 3 mepivacaine and 1 ropivacaine) and 174 (68%) with the combination of two anaesthetics (68 lidocaine+bupivacaine, 94 lidocaine+ropivacaine and 12 lidocaine+mepivacaine), in 3 cases the anaesthetic was unknown. With both one anaesthetic and two in combination, a significant reduction in treated arrhythmias was documented in the first hour after the block (Figure 1). The percentage of procedures followed by complete suppression of treated arrhythmias in the first hour after the procedure was significantly higher when a combinations of anaesthetics was used (91% vs. 66%, p‹0.01). However, the extent of arrhythmia reduction at one hour was similar when comparing different pairs of anaesthetics (Figure 2). On multivariate analysis, adjusted for tachycardia cycle, number of intravenous antiarrhythmic drugs used and number of arrhythmias treated in the previous hour, the use of two anaesthetic drugs was significantly associated with the probability of having complete suppression of arrhythmias in the following hour [OR 4.3 (1.6–11.1), p‹0.01]. Conclusions PSGB reduced the number of treated arrhythmias both when performed with two LAs and with a single LA. However, although there were no differences between the drug pairs administered, the use of two anaesthetics was independently associated with the probability of having complete suppression of arrhythmias in the first hour after the procedure.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".