Carotid sinus massage: A reconsideration in supraventricular tachycardia

Abstract

Background: Supraventricular tachycardia (SVT) is attributable to the orthodromic re-entry phenomenon when tachycardia is secondary to normal anterograde electrical conduction. Objective: To determine the clinical efficacy of carotid sinus massage in terminating the episode of supraventricular tachycardia and the incidence of adverse events associated with carotid sinus massage. Methods: A Quasi experimental pretest post-test study was conducted in the emergency department of CMH Multan after Institutional ethical approval (13/Trg, ERC no. 22/2024) from 20th March to 15th June 2024. This study involved 200 patients, above 25 years of age, presenting to the emergency department with palpitations. Standard 12 lead electrocardiogram was done to diagnose SVT. After informed consent was obtained, patients were placed supine with the neck slightly extended and turned to the opposite side. Carotid sinus massage (CSM) was done, and patients were retained in the emergency detention room. The efficacy of CSM was assessed by termination of SVT within 30 seconds of CSM and incidence of its adverse events was noted during or 1 hour after the CSM procedure. Results: The mean age of study participants was 35.55±8.6 years and the majority were females (59.5%). The CSM was successful in terminating SVT in 18.5% of the patients. The frequency of adverse events of CSM was dizziness (3.5%), vomiting (2.5%), syncope (1.5%), exacerbation of arrhythmia (3.5%), and temporary neurologic complications (1%). The success rate of CSM was higher in non-diabetic patients (p=0.020) and those reporting within 2 hours of the onset of the first episode of SVT(p=0.000). Conclusion: Carotid sinus massage is an effective and safe intervention for early-on spot management of supraventricular tachycardia.