The Reverse Vagal Manoeuvre for SVT

A NEW technique for reverting SVT was published in AJEM(1) this week. The Reverse Vagal manoeuvre for SVT, is simple and safe and in a limited case series, VERY effective.

SVT is not an uncommon patient presentation in the emergency department. In many cases the patient has had SVT before and knows what is happening. However there is no simple way for them to revert to sinus rhythm. This new reverse vagal manoeuvre for SVT, is something that the patient can easily learn and perform.

Previously we have discussed the REVERT trial where positive Valsalva via a syringe, plus a manoeuvre of lifting the legs was used ie., several assistants who know what they are doing, are needed. This new technique is simple and can be performed by the patient with no need for syringes or leg lifting or anything else.

The Technique

A Valsalva manoeuvre is again used with the aim of increasing vagal tone and reversing the SVT. It takes about 10 seconds. There are 4 easy steps involved:

1. Fully exhale, but not forcefully
2. Pinch you nose and close your mouth tightly
3. Try and inhale against closed nose and mouth for 10 seconds, without swallowing
4. Release

What they did

• This is a case series of 11 patients
• 10 of the 11 cases reverted(91%), and in some cases other vagal manoeuvres had not worked.

What’s next?

We certainly need a randomised trial next, however I can’t see any harm in trying this procedure now, as long as we take all the necessary precautions of having the patient in bed etc.,, so they don’t have a vaso-vagal and fall and injure themselves.

I’ve used the technique and it has worked very well.

Reference

1. Gaudart P et al. The reverse vagal manoeuvre: A new tool for treatment of supra ventricular tachycardia? Am J Emerg Med. 2021 Mar;41:66-69.