Acil serviste stabil dar ve geniş QRS kompleksli taşikardi tedavisinde çeşitli valsalva manevralarının etkinliğinin karşılaştırılması
Abstract
Amaç: Dar ve geniş QRS kompleksli taşikrdilerin acil servise sık başvuru aritimi nedenlerindendir. Stabil dar ve geniş QRS taşikardisi olan hastaların tedavisinde önerilen ilk basamak vagal manevradır. Vagal stimülasyonu sağlayabilecek pek çok manevra olmasına rağmen en etkili vagal manevra hala bilinmemektedir. Bu çalışma en
sık kullanılan dört manevrayı karşılaştırarak en etkili vagal manevrayı belirlemeyi amaçlamaktadır.
Gereç ve yöntem: Bu çalışmaya dahil edilen 132 hasta rastgele ve eşit olarak dört gruba dağıtıldılar. Birinci gruba karotis sinüs masajı (KSM), ikinci gruba REVERT yöntemi (10 cc'lik enjektör kullanıldı), üçüncü gruba modifiye REVERT yöntemi (60 cc'lik enjektör kullanıldı), ve dördüncü gruba abeslang (tahta dil bastırıcı) yöntemi
uygulandı. Bu dört uygulama sırasında hastaların yaşamsal bulguları izlendi ve herhangi bir acil durum için
hazırlık yapıldı.
Bulgular: Çalışmaya alınan 132 hastanın 61'i (%46,2) erkek, 71'i (%53,8) kadındı. Hastaların yaş ortalaması 56,3 idi. Hastaların 126’sında dar QRS taşikardileri ve 6’sında stabil geniş QRS taşikardileri vardı. Hastalar rastgele 4 gruba dağıtıldı. 1. grupta 1 hasta (%3) KSM yöntemi ile normal ritme döndü. 2. grupta ise 3 hasta (%9,1) REVERT yöntemi ile normal ritmine döndü. 3. Gruptaki 9 hasta (%27,3) modifiye REVERT yöntemi ile normal ritme döndü. 4. gruptaki 6 hasta (%18,2) abeslang yöntemi ile normal ritme döndü. Stabil geniş QRS taşikardilerinin hiçbiri vagal stimülasyon yöntemlerine yanıt vermedi.
Sonuç: Acil servise stabil dar/geniş QRS taşikardi şikayetiyle başvuran hastalara vagal manevranın uygulanacağı durumda öncelikle modifiye REVERT ve abeslang yönteminin tercih edilmesini önerir. Öte yandan, stabil geniş QRS taşikardi yönetiminde vagal manevranın etkin olmadığı saptanmıştır.
References
- 1. Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology. Eur Heart J 2020;41:655-720. https://doi.org/10.1093/eurheartj/ehz467
- 2. Brembilla Perrot B, Houriez P, Beurrier D, et al. Influence of age on the electrophysiological mechanism of paroxysmal supraventricular tachycardias. Int J Cardiol 2001;78:293-298. https://doi.org/10.1016/s0167-5273(01)00392-8
- 3. Ornato JP, Hallagan LF, Reese WA, et al. Treatment of paroxysmal supraventricular tachycardia in the emergency department by clinical decision analysis. Am J Emerg Med 1988;6:555-560. https://doi.org/10.1016/0735-6757(88)90090-3
- 4. Mehta D, Wafa S, Ward DE, Camm AJ. Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia. Lancet 1988;1:1181-1185. https://doi.org/10.1016/s0140-6736(88)92008-9
- 5. Wen ZC, Chen SA, Tai CT, Chiang CE, Chiou CW, Chang MS. Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia. Circulation 1998;98:2716-2723. https://doi.org/10.1161/01.cir.98.24.2716
- 6. Lim SH, Anantharaman V, Teo WS, Goh PP, Tan AT. Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med 1998;31:30-35.
- 7. Appelboam A, Reuben A, Mann C, et al. REVERT trial collaborators. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet 2015;386:1747-1753. https://doi.org/10.1016/S0140-6736(15)61485-4
- 8. Collins AN, Higgins GL. Reconsidering the effectiveness and safety of carotid sinus massage as a therapeutic intervention in patients with supraventricular tachycardia. Am J Emerg Med 2015;33:807-809. https://doi.org/10.1016/j.ajem.2015.02.047
- 9. Niehues LJ, Klovenski V. Vagal Maneuver. Treasure Island (FL). Available at: https://www.ncbi.nlm.nih.gov/books/NBK551575/. Accessed Semtember 18, 2022
Comparison of the effectiveness of various valsalva maneuvers in the management of stable narrow and wide QRS complex tachycardia in the emergency department
Abstract
Purpose: Narrow and wide QRS complex tachycardias are among the causes of arrhythmia in patients frequently admitted to the emergency department (ED). The first recommended step in the management of patients with a stable narrow and wide QRS tachycardia is a vagal maneuver. Althougah there are many maneuvers that can
provide vagal stimulation, the most effective vagal maneuver is still unknown. This study aims at determining the most effective vagal maneuver by comparing the four most commonly used maneuvers.
Materials and methods: One hundred and thirty-two patients were included in this study; they were randomly and equally distributed into four groups. Carotid sinus massage (CSM) was applied to the first group, the REVERT method was applied to the second group (a 10-cc injector was used), a modified REVERT method was applied to the third group (a 60-cc injector was used), and the abeslang (wooden tongue depressor) method was applied to the fourth group. During these four applications, the patients’ vital signs were monitored, and preparations were made for any emergency.
Results: Of the 132 patients included in the study, 61 (46.2%) were males, and 71 (53.8%) were females. The average age of the patients was 56.3 years. One hundred and twenty-six had narrow QRS tachycardias, and 6 had stable wide QRS tachycardias. The patients were randomly distributed into 4 groups. In the 1st group, 1 patient (3%) returned to a normal rhythm with the CSM method. In the 2nd group, 3 patients (9.1%) returned to a normal rhythm with the REVERT method. Nine patients (27.3%) in the 3rd group returned to a normal rhythm with the modified REVERT method. 6 patients (18.2%) in the 4th group returned to normal rhythm with the abeslang method. None of the stable wide QRS tachycardias responded to vagal stimulation methods.
Conclusion: The modified REVERT and abeslang methods are preferred primarily in patients entering the ED
with the complaint of a stable narrow or wide QRS tachycardia in the case that a vagal maneuver is to be applied.
On the other hand, a vagal maneuver is not effective in the management of a stable wide QRS tachycardia.
Keywords
Emergency department narrow QRS tachycardia wide QRS tachycardia vagal maneuvers valsalva maneuver
References
- 1. Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology. Eur Heart J 2020;41:655-720. https://doi.org/10.1093/eurheartj/ehz467
- 2. Brembilla Perrot B, Houriez P, Beurrier D, et al. Influence of age on the electrophysiological mechanism of paroxysmal supraventricular tachycardias. Int J Cardiol 2001;78:293-298. https://doi.org/10.1016/s0167-5273(01)00392-8
- 3. Ornato JP, Hallagan LF, Reese WA, et al. Treatment of paroxysmal supraventricular tachycardia in the emergency department by clinical decision analysis. Am J Emerg Med 1988;6:555-560. https://doi.org/10.1016/0735-6757(88)90090-3
- 4. Mehta D, Wafa S, Ward DE, Camm AJ. Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia. Lancet 1988;1:1181-1185. https://doi.org/10.1016/s0140-6736(88)92008-9
- 5. Wen ZC, Chen SA, Tai CT, Chiang CE, Chiou CW, Chang MS. Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia. Circulation 1998;98:2716-2723. https://doi.org/10.1161/01.cir.98.24.2716
- 6. Lim SH, Anantharaman V, Teo WS, Goh PP, Tan AT. Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med 1998;31:30-35.
- 7. Appelboam A, Reuben A, Mann C, et al. REVERT trial collaborators. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet 2015;386:1747-1753. https://doi.org/10.1016/S0140-6736(15)61485-4
- 8. Collins AN, Higgins GL. Reconsidering the effectiveness and safety of carotid sinus massage as a therapeutic intervention in patients with supraventricular tachycardia. Am J Emerg Med 2015;33:807-809. https://doi.org/10.1016/j.ajem.2015.02.047
- 9. Niehues LJ, Klovenski V. Vagal Maneuver. Treasure Island (FL). Available at: https://www.ncbi.nlm.nih.gov/books/NBK551575/. Accessed Semtember 18, 2022
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | August 2, 2023 |
| Publication Date | January 1, 2024 |
| Submission Date | June 11, 2023 |
| Acceptance Date | July 26, 2023 |
| Published in Issue | Year 2024 Volume: 17 Issue: 1 |
Cite
