Ventricular Tachycardia Terminated by Vagal Maneuvers

The majority of patients presenting to the emergency department with a stable, regular, monomorphic, wide complex tachycardia will be diagnosed with ventricular tachycardia, with a minority of these patients being diagnosed with supraventricular tachycardia (SVT) with aberrant conduction. Vagal maneuvers may be performed as a first-line treatment for these patients, primarily for the treatment of potential SVT with aberrant conduction.

A 62-year-old woman presented to the emergency department with syncope and palpitations. Her electrocardiogram revealed a regular tachycardic rhythm with a widened monomorphic QRS pattern. The patient converted to a sinus rhythm with a narrow QRS pattern with a modified Valsalva maneuver. Further work up of the patient revealed it was ventricular tachycardia as the presenting rhythm. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given their benign nature, vagal maneuvers may be a useful initial therapeutic option for the treatment of stable, regular, monomorphic wide complex tachycardia. They may be effective at terminating not only SVT with aberrant conduction, but also some types of ventricular tachycardia.