Vagal maneuvers and pharmacological cardioversion in stable PSVT: A systematic review with implications for emergency nursing practice
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Updated: Oct 31, 2026

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M González-García1,2,3, L Carrillo-Franco1,2,3, C Morales-Luque1,2,3
1Department of Human Physiology, Faculty of Medicine, University of Malaga, Málaga, Spain.
Abstract:
Paroxysmal supraventricular tachycardia (PSVT) is a common arrhythmic emergency for which vagal maneuvers offer a non-pharmacological route to cardioversion before drug escalation. This systematic review compared the effectiveness and safety of vagal maneuvers-particularly the standard and modified Valsalva maneuvers-against pharmacological cardioversion in adults with stable PSVT. Following PRISMA 2020 guidance, eleven studies published between 2014 and 2024 were identified across six databases and synthesized narratively owing to clinical and methodological heterogeneity. The modified Valsalva maneuver consistently achieved higher cardioversion rates than the standard technique and carotid sinus massage, with a favorable safety profile, while adenosine remained effective but more frequently associated with recurrence and discomfort. Effectiveness varied by age, arrhythmia subtype, and care setting. Collectively, the evidence supports the modified Valsalva maneuver as a safe, low-cost, first-line option before pharmacological escalation, with particular relevance to nurse-led management in emergency and prehospital care.
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