Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage
Abstract
Study objective To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED.Methods This prospective, randomized case study was performed in the ED of a tertiary care institution. Patients were at least 10 years of age with regular narrow complex tachycardia and had an ECG diagnosis of SVT. Patients with regular narrow complex tachycardia were randomly assigned to undergo either the Valsalva maneuver or CSM. If the tachycardia was not terminated by the method chosen by randomization, then the alternative method of vagal maneuver was used. If the tachycardia was not converted by both methods of vagal stimulation, patients would undergo either synchronized electrical cardioversion or a pharmacologic method of conversion at the discretion of the treating physician, depending on the patient's hemodynamic status.Results One hundred forty-eight instances of SVT were studied. Sixty-two patients underwent Valsalva maneuver first with conversion in 12 (success rate of 19.4%). Eighty-six underwent CSM first with conversion in 9 (success rate 10.5%). Carotid sinus massage was used in the 50 cases of SVT in which conversion was not achieved with the Valsalva maneuver. Conversion occurred in 7 cases (success rate 14.0%). For the 77 cases of SVT in which initial CSM did not achieve conversion, conversion occurred in 13 with the Valsalva maneuver (success rate 16.9%). The Valsalva maneuver and CSM achieved conversion in a total of 41 instances of SVT (success rate 27.7%).Conclusion Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM. [Lim SH, Anantharaman V, Teo WS, Goh PP, Tan ATH: Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med January 1998;31:30-35.].
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Vagal manoeuvres terminate SVT in 19.4-54% of cases, with higher success when the patient is supine.
“Effectiveness of vagal manoeuvres in terminating SVT has been reported as between 19.4 -54%, 66 -68 with higher success rates in the supine position.69”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [66]
Vagal manoeuvres for orthodromic AVRT can be first-line treatment with a success rate of approximately 50%.
“Non-invasive approaches for orthodromic AVRT with vagal manoeuvres, including Valsalva and carotid sinus massage, could represent the first-line treatment with a success rate of approximately 50% (Table 16).66 -68”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [66]
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- Authors
- Lim, S., Anantharaman, V, Teo, W., Goh, P., & Tan, A.
- Venue
- Annals of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 1998-01
- Volume
- 31
- Issue
- 1
- Pages
- 30-35
- ISSN
- 0196-0644 (ISSN-L)
- OpenAlex
- W2067245155
- Cited by
- 176
- References
- 17
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 9 · 2020: 5 · 2019: 10 · 2018: 9 · 2017: 13 · 2016: 9 · 2015: 17 · 2014: 7 · 2013: 5 · 2012: 6
- FWCI
- 2.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- supraventricular tachycardia, Valsalva maneuver, carotid sinus massage, vagal maneuvers, narrow complex tachycardia, emergency department management, electrical cardioversion
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