For acute termination of supraventricular tachycardia (SVT), vagal maneuvers, including the standard Valsalva maneuver (sVM), modified Valsalva (mVM) maneuver, and carotid sinus massage (CSM), are first-line interventions. There is no criterion standard technique.
This prospective, randomized study was aimed at analyzing the success rates of these 3 vagal maneuvers as measured by sustaining sinus rhythm at the fifth minute and SVT termination.
We conducted this prospective, randomized controlled study in an emergency department (ED). We enrolled all the patients who were admitted to the ED and diagnosed with SVT. We randomly assigned them to 3 groups receiving sVM, mVM, and CSM and recorded the patients’ responses to the vagal maneuvers and SVT recurrence after vagal maneuvers.
The study was completed with 98 patients. A total of 25 (25.5%) instances of SVT were initially treated successfully with vagal maneuvers. The success rate was 43.7% (14/32 cases) from mVM, 24.2% (8/33) for sVM, and 9.1 % (3/33) for CSM (p < 0.05). At the end of the fifth minute, only 12.2% (12/98) of all patients had sinus rhythm. Sinus rhythm persisted in 28.1% (9/32) of patients in the mVM group, 6.1% (2/33) of patients in the sVM group, and 3% (1/33) in the CSM group at the fifth minute (p < 0.05).
mVM is superior to the CSM maneuver in terminating SVT and maintaining rhythm. We conclude that it is beneficial to use mVM, which is more effective and lacks side effects.
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- Impact of a modified Valsalva manoeuvre in the termination of paroxysmal supraventricular tachycardia.Emerg Med J. 2010; 27: 287-291
- Alternative treatment options for atrioventricular-nodal-reentry tachycardia: an emergency medicine review.J Emerg Med. 2018; 54: 198-206
- Effectiveness of the Valsalva manoeuvre for reversion of supraventricular tachycardia.Cochrane Database Syst Rev. 2015; 2: CD009502
- Novel vagal maneuver technique for termination of supraventricular tachycardias.Am J Emerg Med. 2016; 34: 118.e5-118.e7
- Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial.Lancet. 2015; 386: 1747-1753
- Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: a randomized controlled trial.Am J Emerg Med. 2017; 35: 1662-1665
- 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.Heart Rhythm. 2016; 13: e136-e221
- Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage.Ann Emerg Med. 1998; 31: 30-35
- Influence of age and gender on the mechanism of supraventricular tachycardia.Heart Rhythm. 2004; 1: 393-396
- Accuracy of arrhythmia recognition in paramedic treatment of paroxysmal supraventricular tachycardia: a ten-year review.Prehosp Emerg Care. 2004; 8: 166-170
- To decide medical therapy according to ECG criteria in patients with supraventricular tachycardia in emergency department: adenosine or diltiazem.Int J Clin Exp Med. 2015; 8: 9692-9699
- Paroxysmal supraventricular tachycardia: outcome after ED care.Am J Emerg Med. 2001; 19: 40-42
- Vagal techniques for termination of paroxysmal supraventricular tachycardia.Am J Cardiol. 1980; 46: 655-664
- Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia.Lancet. 1988; 331: 1181
- Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia.Circulation. 1998; 98: 2716-2723
- Reconsidering the effectiveness and safety of carotid sinus massage as a therapeutic intervention in patients with supraventricular tachycardia.Am J Emerg Med. 2015; 33: 807-809
Published online: August 20, 2019
Accepted: June 8, 2019
Received in revised form: May 8, 2019
Received: February 13, 2019
Reprints are not available from the authors.
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