Alessia Currao, Veronica DUSI, M Casula, Raimondo Pittorru, Enrico Baldi, Filippo Angelini, G Binaghi, Federico Migliore, Edoardo Gandolfi, Giacomo Mugnai, Domenico Tavella, Francesco Notaristefano, Matteo D’Ammando, Gabriele Dell’Era, R Falcetti, Giuseppe Sangiorgi, Giuseppe D’Angelo, Marco Scaglione, Claudia Colombo, Enrica Talini, Francesco De Sensi, Alessandro Paoletti Perini, Enrico Chieffo, Valeria Carinci, Simone Persampieri, Gaetano Maria De Ferrari, Simone Savastano, all the STAR study group, Vito Joseph Sgromo, Francesca Romana Gentile, Silvia Miette Pontremoli, Sara Bendotti, Roberto Primi, Leila Ulmanova, Arianna Morena, Laura Frigerio, Giulio Conte, Pietro Rossi, Simone Frea, Carol Gravinese, Antonio Toscano, Gianmarco Iannopollo, Pasquale Crea, Giuseppe Dattilo, Nastasia Mancini, Marco Corda, Gianfranco Tola, E Cesarano, Claudia Scudu, Alessandro Lupi, G Patti, Claudia Carassia, Federica De Vecchi, S Vargiu, Giovanni Battista Perego, Giulia Girardengo, N Tanese, Lucy Barone, Sara Compagnoni, Tommaso Sanna, Lorenzo Spighi, Nicolò Sisti, Marzia Giaccardi, Giulio Boggian
AIMS: Percutaneous stellate ganglion block (PSGB) is a promising treatment for refractory electrical storm (ES). However, there is a lack of solid indications regarding the optimal pharmacological regimens and combination of local anaesthetics (LAs). This study, from the multicentre STAR registry, aimed to evaluate the impact of single vs. dual LA regimen on the efficacy and safety of PSGB. METHODS AND RESULTS: We analysed 422 PSGB procedures from 298 patients (30% single LA, 70% dual LAs). Both regimens significantly reduced the number of treated ventricular arrhythmias (VAs) in the 12 h post-PSGB. Crucially, the combination of two LAs-typically pairing a fast-acting with a long-acting agent-resulted in a significantly higher rate of complete VA suppression at 1 h (85% vs. 70%, P < 0.01) and 3 h (78% vs. 67%, P = 0.02) compared with the single LA regimen. This superior early efficacy was confirmed after propensity score matching and multivariable analysis. The total complication rate, driven by minor ones, was higher with two LAs (8% vs. 2%, P = 0.02), but this association was no longer significant after adjusting for the procedural approach (lateral vs. anterior). CONCLUSION: The combination of two local anaesthetics for PSGB is significantly associated with a greater likelihood of early and complete ventricular arrhythmia suppression in patients with electrical storm. Despite the need for randomized ad hoc trials, the dual-LA regimen represents an optimization strategy for PSGB, offering enhanced efficacy without an increased risk of major complications.