Use of the human dive reflex for the management of supraventricular tachycardia: a review of the literature

Abstract

BackgroundThe human dive reflex (HDR), a physiological phenomenon similar to the bradycardia reflex used by marine mammals during prolonged submersion, can be employed in managing paroxysmal supraventricular tachycardia (PSVT). This review aims to identify a standardised HDR technique for haemodynamically stable PSVT, to determine the effectiveness of the HDR and to define its usefulness in the prehospital setting. Methods A review of the Medline, EMBASE and CINAHL databases was conducted. Articles were included if they described the use of the HDR to revert PSVT in the prehospital or emergency medical setting, the nature of the effectiveness of the HDR for PSVT or historically significant developments of HDR techniques for PSVT reversion. Articles not available in English or describing the use of HDR in animal studies only were excluded. Results 211 articles were identified, of which 21 were found to be relevant. These included 10 studies of HDR effectiveness in PSVT and three physiological studies of HDR effect. No standardised model of performance exists for the HDR. Elements of performance include: a cold stimulus applied to the entire face, a specific temperature of the cold stimulus, application duration, breath holding during HDR and posture assumed to perform the procedure. There are also safety and logistics issues with using the HDR in prehospital care. Conclusions The HDR represents an effective method of terminating PSVT in the hospital emergency department. Its usefulness in prehospital care requires further evaluation of the elements of the manoeuvre to determine appropriateness to this setting. BACKGROUND

Parasympathetic preganglionic cardiac motoneurons labeled after voluntary diving

“…Our past efforts have been directed toward defining the neural circuitry driving the dramatic bradycardia, the peripheral vasoconstriction, and apnea induced by a somatic stimulus that defies normal homeostatic parameters. Once the neural circuit for the remarkable mammalian diving response is finalized, it may provide a substrate for understanding its use in both diagnostic and therapeutic measures in humans (Leiter and Böhm, 2007; Pedroso et al, 2012; Smith et al, 2012). …”

State of the art paper The trigeminocardiac reflex – a comparison with the diving reflex in humans

“…A recent review highlighted the clinical implications of these reflexes. The DR has been used to treat supraventricular tachycardia (SVT) [ 56 ]. This reflex is incited by various maneuvers including immersion of the face in preset cold water and breath holding exercises.…”

Effectiveness of anxiety reduction interventions on test anxiety: A comparison of four techniques incorporating sensory modulation

“…Changes in both the parasympathetic and sympathetic systems result in reduced cardiac and vascular activity (Gooden, 1994; Leuenberger et al., 2001). As a stand-alone intervention, it has been found to relieve anxiety and assist with treating tachycardia (Smith et al., 2012). The dive reflex uses temperature (touch sensory input) to elicit a physiological response, and as such can be considered a sensory modulation technique in the management of anxiety.…”