R.E.B.E.L.EM - By Salim Rezaie - October 17, 2019
"Background: In patients with hemodynamically stable supraventricular tachycardia (SVT), vagal maneuvers are the traditional first step in management. There are several vagal techniques in the literature which include, standard valsalva maneuver (sVM), modified Valsalva maneuver (mVM), and carotid sinus massage (CSM). All three techniques aim to increase vagal tone to slow down conduction in the AV node and, hopefully, result in termination of Atrioventricular nodal reentry tachycardia (AVNRT)and atrioventricular reentrant tachycardia (AVRT). The authors of this trial performed a RCT evaluating the effectiveness of sVM vs mVM vs CSM at not only terminating SVT but also having a sustained effect up to 5 minutes...
Author 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.”
Clinical Take Home Point: Although not statistically significant in this study, this is the third RCT to show the superiority of mVM compared sVM with significantly more patients with sustained NSR at the 5-minute mark. Both mVM and sVM were both superior to CSM."