Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia

Lancet. 1988 May 28;1(8596):1181-5. doi: 10.1016/s0140-6736(88)92008-9.


The ability of four vagotonic physical manoeuvres to terminate paroxysmal junctional tachycardias was tested in 35 patients with inducible and sustained arrhythmia. Each manoeuvre was used up to three times in an attempt to terminate an induced tachycardia and was judged to be effective if it terminated two out of the three induced episodes. The Valsalva manoeuvre in the supine position was effective in 19 (54%), right carotid sinus massage in 6 (17%), left carotid sinus massage in 2 (5%), and the diving reflex in 6 (17%) cases. 4 of the 6 patients who responded to right carotid sinus massage and all patients who responded to the diving reflex also responded to the Valsalva manoeuvre. The Valsalva manoeuvre while standing was effective in 9 (20%) patients only. Patients in whom the manoeuvres terminated the tachycardias were significantly younger than those who did not respond (median age: 30 vs 45 years, p less than 0.01). Physical manoeuvres were much more successful in terminating atrioventricular re-entry tachycardias (19/24) than atrioventricular nodal re-entry tachycardias (3/11, p less than 0.01). Efficacy of the manoeuvres was related to their bradycardic effect in sinus rhythm.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Carotid Artery, External*
  • Electrodes, Implanted
  • Evaluation Studies as Topic
  • Face*
  • Female
  • Heart Block / physiopathology
  • Heart Rate
  • Humans
  • Immersion*
  • Infant, Newborn
  • Male
  • Massage*
  • Middle Aged
  • Posture
  • Random Allocation
  • Tachycardia / physiopathology
  • Tachycardia, Atrioventricular Nodal Reentry / physiopathology
  • Tachycardia, Ectopic Junctional / physiopathology
  • Tachycardia, Ectopic Junctional / therapy*
  • Tachycardia, Supraventricular / therapy*
  • Valsalva Maneuver*