Abstract
IntroductionSupraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM).MethodsWe conducted a randomised controlled trial at an acute hospital ED. Patients presenting with SVT were randomly assigned to HDDB or modified VM in a 1:1 ratio. A block randomisation sequence was prepared by an independent biostatistician, and then serially numbered, opaque, sealed envelopes were opened just before the intervention. Patients and caregivers were not blinded. Primary outcome was cardioversion to sinus rhythm. Secondary outcome(s) included adverse effects/complications of each technique.ResultsA total of 41 patients were randomised between 1 August, 2018–1 February, 2020 (20 HDDB and 21 modified VM). Amongst the 41 patients, three spontaneously cardioverted to sinus rhythm before receiving the allocated treatment and were excluded. Cardioversion was achieved in six patients (31.6%) and seven patients (36.8%) with HDDB and modified VM, respectively (odds ratio 1.26, 95% confidence interval, 0.33, 4.84, P = 0.733). Seventeen (89.5%) patients in the HDDB group and 14 (73.7%) from the modified VM group did not encounter any adverse effects. No major adverse cardiovascular events were recorded.ConclusionBoth the head down deep breathing technique and the modified Valsalva manoeuvre appear safe and effective in cardioverting patients with SVT in the ED.
Highlights
Supraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED)
Cardioversion was achieved in six patients (31.6%) and seven patients (36.8%) with head down deep breathing (HDDB) and modified Valsalva manoeuvre (VM), respectively
In the absence of an established diagnosis at the ED and after ruling out irregular narrow complex tachycardias which are usually due to atrial fibrillation, vagal manoeuvres are recommended as acute therapy for this group of patients.[2]
Summary
In the absence of an established diagnosis at the ED and after ruling out irregular narrow complex tachycardias which are usually due to atrial fibrillation, vagal manoeuvres are recommended as acute therapy for this group of patients.[2] Previously, we have described the head down deep breathing (HDDB) technique as a reasonable and simple alternative to other vagal manoeuvres for the management of paroxysmal SVT at the ED.[3] In this study, we assessed the HDDB method with the commonly practised, modified Valsalva manoeuvre (REVERT study)[4,5] and compared the rates of successful cardioversion of SVT to sinus rhythm between the two groups. Our hypothesis is that HDDB is a safe and efficacious method for conversion of stable SVT
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