Acute effects of unilateral temporary stellate ganglion block on human atrial electrophysiological properties and atrial fibrillation inducibility

• Published in: Heart rhythm Vol. 13; no. 11; pp. 2111 - 2117
• Main Authors: Leftheriotis, Dionyssios, Flevari, Panayota, Kossyvakis, Charalampos, Katsaras, Dimitrios, Batistaki, Chrysanthi, Arvaniti, Chrysa, Giannopoulos, Georgios, Deftereos, Spyridon, Kostopanagiotou, Georgia, Lekakis, John
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Anti-Arrhythmia Agents - administration & dosage; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Atrium; Autonomic Nerve Block - methods; Block; Cardiovascular; Electrophysiology; Female; Heart Atria - drug effects; Heart Atria - physiopathology; Heart Conduction System - drug effects; Heart Conduction System - physiopathology; Heart Rate - drug effects; Humans; Lidocaine - administration & dosage; Male; Middle Aged; Pulmonary Veins - surgery; Refractory Period, Electrophysiological - drug effects; Stellate ganglion; Stellate Ganglion - physiopathology; Treatment Outcome; Electrophysiology; Atrium; Block; Stellate ganglion; Atrial fibrillation
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2016.06.025

In experimental models, stellate ganglion block (SGB) reduces the induction of atrial fibrillation (AF), while data in humans are limited. The aim of this study was to assess the effect of unilateral SGB on atrial electrophysiological properties and AF induction in patients with paroxysmal AF. Thirty-six patients with paroxysmal AF were randomized in a 2:1 order to temporary, transcutaneous, pharmaceutical SGB with lidocaine or placebo before pulmonary vein isolation. Lidocaine was 1:1 randomly infused to the right or left ganglion. Before and after randomization, atrial effective refractory period (ERP) of each atrium, difference between right and left atrial ERP, intra- and interatrial conduction time, AF inducibility, and AF duration were assessed. After SGB, right atrial ERP was prolonged from a median (1st-3rd quartile) of 240 (220–268) ms to 260 (240–300) ms (P < .01) and left atrial ERP from 235 (220–260) ms to 245 (240–280) ms (P < .01). AF was induced by atrial pacing in all 24 patients before SGB, but only in 13 patients (54%) after the intervention (P < .01). AF duration was shorter after SGB: 1.5 (0.0–5.8) minutes from 5.5 (3.0–12.0) minutes (P < .01). Intra- and interatrial conduction time was not significantly prolonged. No significant differences were observed between right and left SGB. No changes were observed in the placebo group. Unilateral temporary SGB prolonged atrial ERP, reduced AF inducibility, and decreased AF duration. An equivalent effect of right and left SGB on both atria was observed. These findings may have a clinical implication in the prevention of drug refractory and postsurgery AF and deserve further clinical investigation.