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Adenosine has reached "standard of care" status for the emergency management of supraventricular tachycardia (SVT). However, stimulation of the vagus nerve, used to control rapid heartbeat since at least the late 18th century, is a valid, often effective method of terminating SVT. This randomized study compared two methods of vagal stimulation: the Valsalva maneuver (produced by having the patient blow into a high-resistance tube) and carotid sinus massage (CSM).
CSM was not attempted in patients with carotid bruits or a stroke history. If vagal maneuvers failed to convert narrow complex tachycardia to sinus rhythm, patients received adenosine or were DC cardioverted. Of 148 cases of SVT, 19.4% of those randomized to the Valsalva maneuver co…