Date of Award

2026

Document Type

Capstone

Degree Name

Master of Science (MS)

Department

Physician Assistant Studies

Committee Chair

Trey Boyd

Abstract

INTRODUCTION: SVT is a well-known and potentially life-threatening arrhythmia, with vagal maneuvers and/or antiarrhythmic drugs often attempted for first-line conversion. The purpose of this clinical review is to analyze the relative effectiveness and success rates of these specific maneuvers and medications.

METHODS: The following PubMed database search was performed:“((vagal maneuver*) OR (valsalva)) AND (pharmacologic) ((medication) OR (medical therapy) OR (adenosine) OR (beta blocker*) OR (calcium channel blocker*) OR (anti-arrhythmic*) OR (anti arrhythmic*) OR (antiarrhythmic)) AND ((SVT) OR (supraventricular tachycardia))”. Filters were then applied and article titles/abstracts reviewed, resulting in a final selection of five articles for review.

RESULTS:. The most effective vagal maneuver found across two studies was modified valsava, with one meta-analysis resulting >40% SVT conversion . Adenosine consistently performed with a higher success rate (~90%) compared to vagal maneuvers (20-40%) in termination of stable SVT, however the latter were still recommended to be attempted first due to their noninvasive and convenient nature. Novel intranasal agents like etrapamil have recently shown efficacy in initial RCT’s for acute termination of SVT, and have the potential for further study.

DISCUSSION: Modified valsalva consistently showed the most favorable results, however only 2-3 attempts should be made prior to deferring to administration of adenosine, with multiple administrations and increased dosing preferred prior to second-line alternatives. Unstable SVT requires synchronized cardioversion.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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