What is the efficacy and safety of different vagal manoeuvres for terminating paroxysmal supraventricular tachycardia?
This review highlights that the Valsalva manoeuvre is the safest and most effective vagal manoeuvre for adults with PSVT, while cautioning against carotid sinus massage in the elderly.
Abstract Vagal manoeuvres are frequently used, with or without drug therapy, in the acute management of paroxysmal supraventricular tachycardia. This review provides the practical details needed to maximise the effectiveness of vagal manoeuvres and reviews the data concerning safety and relative efficacy of these techniques. Vagal manoeuvres should be performed with the patient relaxed and supine to maximise efficacy. The valsalva manoeuvre with sphygmomanometric measurement appears to be the most effective and safest manoeuvre in adults, while the diving reflex has been demonstrated to be successful in children. Carotid sinus massage should be used with caution in the elderly as it is relatively ineffective and carries a small risk of neurological sequelae. Combining techniques to augment each other may prove useful in cases resistant to individual manoeuvres.
Bonnin et al. (Sat,) studied this question.
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