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Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage.
Ann Emerg Med. 1998 Jan; 31(1):30-5.AE

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.

Authors+Show Affiliations

Department of Emergency Medicine, Singapore General Hospital, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9437338

Citation

Lim, S H., et al. "Comparison of Treatment of Supraventricular Tachycardia By Valsalva Maneuver and Carotid Sinus Massage." Annals of Emergency Medicine, vol. 31, no. 1, 1998, pp. 30-5.
Lim SH, Anantharaman V, Teo WS, et al. Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med. 1998;31(1):30-5.
Lim, S. H., Anantharaman, V., Teo, W. S., Goh, P. P., & Tan, A. T. (1998). Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Annals of Emergency Medicine, 31(1), 30-5.
Lim SH, et al. Comparison of Treatment of Supraventricular Tachycardia By Valsalva Maneuver and Carotid Sinus Massage. Ann Emerg Med. 1998;31(1):30-5. PubMed PMID: 9437338.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. AU - Lim,S H, AU - Anantharaman,V, AU - Teo,W S, AU - Goh,P P, AU - Tan,A T, PY - 1998/1/23/pubmed PY - 1998/1/23/medline PY - 1998/1/23/entrez SP - 30 EP - 5 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 31 IS - 1 N2 - 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. SN - 0196-0644 UR - https://www.unboundmedicine.com/medline/citation/9437338/Comparison_of_treatment_of_supraventricular_tachycardia_by_Valsalva_maneuver_and_carotid_sinus_massage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196064498000146 DB - PRIME DP - Unbound Medicine ER -