Abstract
Background
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.
Objective
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 20, 2019
Accepted:
June 8,
2019
Received in revised form:
May 8,
2019
Received:
February 13,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
