Key points about vagal maneuvers
• Vagal maneuvers are a first-line intervention for certain fast heart rhythms like SVT.• They are non-invasive and usually well tolerated.
• Effectiveness may vary depending on the type of arrhythmia and patient factors.
• Medical guidance is important before attempting them independently.
• These maneuvers are often used to avoid or delay medications or more invasive procedures.
Overview of vagal maneuvers
Vagal maneuvers are techniques that activate the vagus nerve to slow electrical signals in the heart. They are commonly used to interrupt episodes of supraventricular tachycardia (SVT). These methods are often tried before medications or procedures and can be performed in both clinical and home settings when appropriate.Candidates for vagal maneuvers
Vagal maneuvers may be appropriate for patients who:• Experience sudden-onset rapid heart rhythms, especially SVT.
• Are stable with no signs of chest pain, low blood pressure, or fainting.
• Have been evaluated by a provider and instructed on proper technique.
• Need a non-pharmacologic option for rhythm control in emergency or outpatient settings.
Preparation for vagal maneuvers
• Little to no formal preparation is typically needed.• A provider may assess vital signs, heart rhythm, and symptoms beforehand.
• Patients may be coached through a specific technique like the Valsalva maneuver or carotid sinus massage (only performed by clinicians).
• Safety precautions are taken to ensure the patient is in a supportive position in case of dizziness or fainting.
Recovery from vagal maneuvers
• Recovery is usually quick, with heart rhythm either restoring to normal or moving on to the next treatment step.• Patients may feel tired or briefly lightheaded after the attempt.
• Monitoring may continue for a short period to assess rhythm and symptoms.
• If the maneuver does not work, medication or electrical cardioversion may be considered.
Risks for vagal maneuvers
Although vagal maneuvers are typically safe, they can carry some risks:• Dizziness, fainting, or low blood pressure.
• Worsening of rhythm in rare cases.
• Risk of stroke if carotid massage is used in patients with carotid artery disease.