Neuromodulation Strategies for Refractory Ventricular Arrhythmias Time to "Tune" the Volume?

The autonomic nervous system is increasingly recognized to play an important role in the genesis of arrhythmic storm (sustained monomorphic ventricular tachycardia [VT] and ventricular fibrillation) in structural heart diseases.1 Several animal and human studies document the relationship between the activation of the stellate ganglion (SG), the sympathetic chain, and ventricular arrhythmia (VA) occurrences. Based on this evidence, multiple approaches for neuromodulation have been proposed; the SG and the sympathetic chain remain the preferred target site for the treatment of VAs.2 Currently, there are different procedures to target the SG percutaneously.3 All of these can be performed safely and routinely. These techniques are largely completed bedside, either by the anesthesia team or the electrophysiology team to temporarily stabilize the patient's rhythm. Temporary stellate ganglion block (SGB) can be achieved via an anatomical approach or with ultrasound guidance. netic stimulation (TcMS) as an alternative source to modulate the SG which involves current induction by as a bridge to stabilize the patient until a radio