Question: We haven't heard much discussion on this topic lately, so could you please detail which vagal maneuvers we are able to perform?

 Great question! The best summary of the role of vagal maneuvers for SVT was written by Dr Bradford in the January 2011 newsletter on page 7. It is a great read and the link is here: http://www.lhsc.on.ca/About_Us/Base_Hospital_Program/SWORBHPLINKSJanuary2011.pdf

While many vagal maneuvers exist, and multiple techniques may have been taught in the past, your ACP Tachydysrhythmia Medical Directive lists the Valsalva Maneuver as the vagal maneuver to be utilized.

Neurologic complications (although extremely rare) have been noted with the use of carotid sinus massage thus the preference with the valsalva technique.

As a reminder, vagal maneuvers alone will terminate up to 25% of SVT so they form an integral component of the care for stable narrow complex tachydysrhythmias (Neumar et al Part 8: Adult Advanced cardiovascular Life Support Circulation Nov 2 2010).

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