Elio Assaad Saad

Background: Ventricular tachycardia storm, defined as recurrent and sustained episodes of ventricular tachycardia leading to hemodynamic instability, is a life-threatening condition with complex management. It is often resistant to multiple therapeutic options, leading to high recurrence and mortality rates. This condition thus imposes significant clinical challenges and necessitates novel approaches. Stellate Ganglion Blockade (SGB) has been reported as a new procedure with promising results. Objective: This systematic review aims to explore the role of stellate ganglion blockade in refractory ventricular tachycardia storm as a therapeutic option by assessing its efficacy, safety, and associated outcomes. Methods: A systematic search was conducted on MEDLINE and Embase, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search strategy relied on PICO model (Population, Intervention, Comparison, Outcomes). Two independent reviewers screened the articles for inclusion & exclusion criteria. Data extraction was conducted for included articles using a standardized data extraction form. All included articles were assessed for their risk of bias with appropriate tools according to their study design. Results: 20 studies were included, representing a pooled sample size of 463 participants. Eleven studies reported the occurrence of ventricular tachycardia and arrhythmias within 72 hours of SGB, with 50.69% of their participants experiencing that occurrence. The calculated odds ratio (OR) for refractory ventricular arrhythmia (VA) occurrence, when compared to standard therapy such as stellate ganglion stimulation or antiarrhythmic medications, is 0.33 (95% CI 0.07-1.44). A favorable OR of 0.35 (95% CI 0.03-3.84) was also calculated for VA recurrence in less than 72 hours after intervention, comparing stellate ganglion blockade to other interventions. 44.22% of participants in studies that reported the occurrence of Horner Syndrome were symptomatic. However, combined with studies reporting independent ptosis, the percentage of participants experiencing Horner Syndrome and/or ptosis falls to 30.1%. Only seven studies reported periprocedural and/or postprocedural complications, with most reporting studies mentioning few to no complications. Furthermore, most complications seemed to resolve within a 2-week to 1-month timeframe. As for cardiovascular mortality following SGB, among the studies reporting it, an OR of 0.21 (95%CI 0.07-0.68) was calculated, favoring the blockade over stimulation or IKr-channel blocker administration in this specific outcome. The odds ratio for all-cause mortality also appeared to be lower in SGB groups than in other interventions/controls, with an odds ratio of 0.03 (95% CI 0.01-0.2). Conclusion: SGB is an effective therapy with a limited side effect profile for patients with refractory ventricular tachycardia storm when considering all-cause mortality as compared to standard therapy. Further long-term data is still needed to consolidate these findings.

Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5–1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.

Palpebral congenital melanocytic nevi (PCMN) is a rare congenital skin lesion affecting the eyelids that can lead to cosmetic and psychological concerns and potential health risks such as malignancy. Several authors have analyzed therapeutical strategies to treat PCMN. However, there was no consensus in the literature. This systematic review aimed to evaluate the effectiveness, safety, and success of treatments of PCMN.