Background Ventricular arrhythmias (VAs), including ventricular tachycardia and ventricular fibrillation, present substantial therapeutic challenges due to their high morbidity, mortality, and increasing prevalence. Current treatments often prove infeasible or inadequate in patients with refractory VAs. Purpose To evaluate the safety and effectiveness of CT-guided left stellate ganglion cryoneurolysis (SGC) in the treatment of refractory VAs. Materials and Methods This retrospective study reviewed all consecutive patients with refractory VAs who underwent SGC between June 2020 and December 2023 at two tertiary care centers. Patients with refractory VAs who underwent CT-guided left SGC were included. No patients were excluded. Data on preprocedural clinical status, procedural approach, procedural outcomes, and adverse events were analyzed. The pre- and postprocedural number of defibrillations were compared using the Wilcoxon matched-pairs signed rank test. Results A total of 17 patients (mean age, 60.4 years ± 2.7 [standard error of the mean]; 14 male) were included; seven patients (41%) were receiving β-adrenergic blocking agents. The mean number of antiarrhythmic medications per patient was 2.2 ± 0.2. CT-guided left SGC led to a significant reduction in defibrillations, from a median of 3 (IQR, 3-15) to 0 (IRQ, 0-0) in the 24 hours before and after the procedure, respectively (P < .001). Clinical success, defined as freedom from defibrillation within the preceding 24-hour period, was achieved in 14 of 17 patients (82%) 24 hours after and 15 of 17 patients (88%) 72 hours after the procedure. Of 17 patients, 12 (71%) proceeded to additional procedural management after SGC. At a mean follow-up of 469.2 days ± 90.8, 14 of 17 patients (82%) were alive. No moderate or high-grade adverse events were observed; mild adverse events included left upper extremity neurapraxia (n = 1) and transient Horner syndrome (n = 3). Conclusion CT-guided left SGC demonstrated promising effectiveness and safety in treating patients with refractory VAs. Thus, SGC warrants consideration for inclusion in a multidisciplinary treatment algorithm for VAs. © RSNA, 2024 See also the editorial by Cadour and Scemama in this issue.

中文翻译：

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CT 引导下左星状神经节冷冻神经松解术治疗难治性室性心律失常。


背景 室性心律失常 （VAs），包括室性心动过速和心室颤动，由于其高发病率、死亡率和患病率增加，带来了巨大的治疗挑战。目前的治疗通常被证明对难治性 VA 患者不可行或不充分。目的 评价 CT 引导下左星状神经节冷冻神经松解术 （SGC） 治疗难治性 VAs 的安全性和有效性。材料和方法 本回顾性研究回顾了 2020 年 6 月至 2023 年 12 月期间在两个三级医疗中心接受 SGC 的所有连续难治性 VA 患者。纳入接受 CT 引导下左 SGC 的难治性 VAs 患者。没有患者被排除在外。分析了术前临床状态、手术方法、手术结局和不良事件的数据。使用 Wilcoxon 匹配对符号秩检验比较除颤的术前和术后数量。结果 共纳入 17 例患者 （平均年龄 60.4 岁 ± 2.7 [平均值的标准误差];14 例男性）;7 例患者 （41%） 正在接受 β-肾上腺素能阻滞剂。每位患者的平均抗心律失常药物数量为 2.2 ± 0.2。CT 引导下左 SGC 导致除颤显着减少，在手术前后 24 小时内分别从中位数 3 （IQR， 3-15） 降至 0 （IRQ， 0-0） （P < .001）。临床成功，定义为在过去 24 小时内没有除颤，17 名患者中有 14 名 （82%） 在手术后 24 小时取得，17 名患者中有 15 名 （88%） 在手术后 72 小时取得。在 17 例患者中，12 例 （71%） 在 SGC 后进行了额外的手术管理。平均随访 469.2 天± 90.8 天时，17 例患者中有 14 例 （82%） 存活。 未观察到中度或高度不良事件;轻度不良事件包括左上肢神经失用症 （n = 1） 和短暂性 Horner 综合征 （n = 3）。结论 CT 引导左 SGC 在治疗难治性 VAs 患者方面显示出良好的有效性和安全性。因此，SGC 值得考虑纳入 VA 的多学科治疗流程。© RSNA，2024 年另见 Cadour 和 Scemama 在本期的社论。