An Alternative Role for the Pain Physician: Utilization of Stellate Block for Treatment Resistant Cardiac Arrhythmias

A pain medicine physician’s unique skill set in interventional techniques may lead to requests to perform a stellate ganglion blockade for ventricular tachyarrhythmias (VT). Although stellate ganglion blocks are a typical block performed in the chronic pain setting, its utilization for cardiac causes is less likely to be a component of formal pain medicine training. VT are often lethal clinical events that can be challenging to treat and may be refractory to traditional beta blockade therapy and other antiarrhythmic therapies. Furthermore, in the setting of sustained VT, or electrical storm (ES), patients are frequently too unstable for ablative procedures or surgical sympathetic denervation. In such scenarios, the need for urgent sympathetic denervation or blockade can be met through utilization of an alternative bedside procedural modality: ultrasound-guided percutaneous stellate ganglion blockade (SGB).