Vagal manoeuvres for acute management of paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia may be converted to sinus rhythm by manoeuvres that enhance vagal tone. These manoeuvres include the Valsalva manoeuvre, the modified Valsalva manoeuvre and carotid sinus massage; they can be performed in a primary care or hospital setting.

For information on the Valsalva manoeuvre, see the REVERT study. For information on the modified Valsalva manoeuvre, see the Royal Australian College of General Practitioners HANDI website.

Carotid sinus massage is difficult to perform correctly and should be avoided in older patients and those with vascular disease.