Carotid sinus massage: is it a safe way to terminate supraventricular tachycardia?

Adlington, H; Cumberbatch, G L A

doi:10.1136/emj.2008.062968

Cited by 10 publications

(2 citation statements)

References 4 publications

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“…Thus, the adverse events might not be critical issues in performing MVM. Although no significantly increased adverse event was noted in the CSM group, some life-threatening complications, such as transient ischemic attack and stroke, had been put forward previously, especially in elderly patients (37,(44)(45)(46)(47)(48).…”

Section: Discussionmentioning

confidence: 80%

Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis

et al. 2022

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BackgroundVagal maneuvers (VagMs) are recommended as the first-line treatment of supraventricular tachycardia (SVT). However, the optimal type of VagMs remains unproven.AimThis study aims to compare the effectiveness and adverse events amongst VagMs on SVT via network meta-analyses (NMAs).MethodsWe systematically searched randomized controlled trials (RCTs) that involved adults with SVT and compared VagMs without language restrictions. We determined the initial and final responses of conversion rate to sinus rhythm and adverse events. Risk of bias (RoB) was appraised by Cochrane revised tool, and contribution matrix was calculated. NMAs were synthesized using frequentist random-effects model and presented as relative risk (RR) with 95% CI. The order of probability was presented as surface under the cumulative ranking curve analysis (SUCRA). Sensitivity analysis was performed using both Bayesian and frequentist approach with fixed- or random-effects models. Certainty of evidence (CoE) was rated by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology.ResultsFourteen RCTs with 2,180 patients were enrolled. Small portion of mixed estimates was contributed from high overall RoB studies. Compared with carotid sinus massage (CSM), the modified Valsalva maneuver (MVM) was the most effective VagM after initial performance [SUCRA: 0.9992, RR: 5.47 (1.77–16.93)] and at the end of study [SUCRA: 1.0000, RR: 3.62 (2.04–6.39), CoE: high]. The standard VM did not elicit better conversion rate to the sinus rhythm than CSM at the initial response [SUCRA: 0.4395, RR: 1.97 (0.63–6.15)] and at the end of the study [SUCRA: 0.4795, RR: 1.64 (0.94–2.87), CoE: moderate]. The SUCRA value of CSM at the initial and final responses was the least one amongst three VagMs (0.0613 and 0.0205, respectively). Adverse events amongst three VagMs were similar (CoE: low). Sensitivity analyses yielded consistent results.ConclusionWe recommended MVM as the first choice of VagM for rhythm conversion before the pharmacological management of SVT.

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Section: Discussionmentioning

confidence: 80%

Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis

et al. 2022

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“…Stimulation results in a decreased rate of discharge and reduces SAN/AVN excitability (via M2 receptors), hence decreasing HR [15]. The right vagus nerve innervates the SAN predominantly, and the left vagus nerve the AVN, which explains why left carotid sinus massage is more likely to be effective in terminating supraventricular tachycardias (SVTs) [16]. Because of the lack of efferent distribution to ventricles, the PNS has little effect on inotropicity.…”

Section: Autonomic Nervous System (Ans)mentioning

confidence: 99%

Mechanisms involved in regulation of Systemic Blood Pressure

Patel¹,

Ali²

2017

Arch Clin Hypertens

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SUMMARYRegulation of the circulatory system to maintain a constant arterial pressure is critical in ensuring adequate perfusion to meet metabolic requirements of tissues. Blood pressure (BP) can be considered in the context of Ohm's law, whereby BP (analogous to voltage) is directly proportional to the product of cardiac output (current) and total vascular resistance (TPR). Acute regulatory mechanisms are coordinated in the cardiovascular control centres in the brainstem, which are themselves infl uenced by impulses from other neural centres in addition to sensors both intrinsic and extrinsic to the circulation. However, certain organs such as the heart, kidneys and brain have the ability to coordinate blood fl ow locally, i.e. autoregulate. This enables alterations in regional perfusion without perturbations of BP. This mini-review provides an exploratory discussion of neural and humoral mechanisms that underpin regulation of systemic BP. Compared with skeletal muscle, they contract more slowly but generate higher forces with sustainable activity. Cell-to-cell conduction is via gap junctions as occurs in the myocardium. Mini Review Mechanisms involved in regulation of Systemic Blood PressureThe interaction between actin and myosin leading to contraction is regulated by intracellular calcium concentration as with other muscle, but the molecular mechanism differs [8].VSMCs lack troponin and fast sodium channels. The increase in intracellular calcium concentration arises from voltage-gated channels and receptor-mediated channels in the sarcolemma, with additional release from the sarcoplasmic reticulum (SR).Agents that can mediate effects via agonism or antagonism of these pathways include nitric oxide (NO), acetylcholine (Ach),

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Abnormalities of Pulse Rhythm

McGee

2018

Evidence-Based Physical Diagnosis

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Carotid sinus massage: is it a safe way to terminate supraventricular tachycardia?

Cited by 10 publications

References 4 publications

Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis

Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis

Mechanisms involved in regulation of Systemic Blood Pressure

Abnormalities of Pulse Rhythm

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