Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia
Abstract
BACKGROUND: The vagal maneuvers used for termination of paroxysmal supraventricular reentrant tachycardia (PSVT) appear to involve more complex mechanisms than we have known, and further study should be done to explore the possible mechanisms. METHODS AND RESULTS: In this study, 133 patients with PSVT and 30 age- and sex-matched control subjects were included. We assessed the effects of different vagal maneuvers on termination of PSVT and compared baroreflex sensitivity and beta-adrenergic sensitivity between the patients with PSVT and control subjects. Out of 85 patients with atrioventricular reciprocating tachycardia (AVRT), vagal maneuvers terminated in 45 (53%). Of these, 28 (33%) terminated in the antegrade limb and 17 (20%) terminated in the retrograde limb. Out of 48 patients with atrioventricular nodal reentrant tachycardia (AVNRT), vagal maneuvers terminated the tachycardia in the antegrade slow pathway (14%) or in the retrograde fast pathway (19%). Baroreflex sensitivity was poorer but isoproterenol sensitivity test better in patients with AVNRT. Poorer antegrade atrioventricular node conduction properties and better vagal response determined successful antegrade termination of AVRT by vagal maneuvers. Poorer retrograde accessory pathway conduction property but better vagal response determined successful retrograde termination of AVRT. Better sympathetic and vagal response associated with poorer retrograde atrioventricular node conduction determined retrograde termination of AVNRT by the Valsalva maneuver. CONCLUSIONS: Both the vagal response and conduction properties of the reentrant circuit determine the tachycardia termination by vagal maneuvers. Improved understanding of the interaction of autonomic and electrophysiological mechanisms in maintaining or terminating PSVT may provide important insight into the pathophysiology of these two tachycardias.
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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 [68]
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 [68]
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- Authors
- Wen, Z.-C., Chen, S.-A., Tai, C.-T., Chiang, C.-E., Chiou, C.-W., & Chang, M.-S.
- Affiliations
- Taipei Veterans General Hospital (TW)
- Venue
- Circulation
- Published
- 1998-12-15
- Volume
- 98
- Issue
- 24
- Pages
- 2716-2723
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2165473148
- Cited by
- 101
- References
- 21
- Citations by year
- 2026: 4 · 2025: 3 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 7 · 2016: 7 · 2015: 13 · 2014: 2 · 2013: 5 · 2012: 4
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Science Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- paroxysmal supraventricular tachycardia, vagal maneuvers, tachycardia termination, atrioventricular reciprocating tachycardia, atrioventricular nodal reentrant tachycardia, baroreflex sensitivity, beta-adrenergic sensitivity, atrioventricular nodal conduction, accessory pathway conduction, Valsalva maneuver, retrograde pathway
- MeSH terms
- Adolescent, Adult, Aged, Electrophysiology, Female, Heart Conduction System, Humans, Male, Middle Aged, Tachycardia, Paroxysmal, Tachycardia, Supraventricular, Vagus Nerve, Autonomic Pathways
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