COMPARISON BETWEEN VAGAL MANEUVERS AND ADENOSINE IN PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

Abstract

Paroxysmal supraventricular tachycardia (PSVT) is one of the most common arrhythmias in clinical practice, characterized by sudden episodes of supraventricular tachycardia. The management of this condition in hemodynamically stable patients is initially based on the use of vagal maneuvers, followed by adenosine administration in cases of failure. This study aimed to compare the effectiveness, safety, and clinical applicability of vagal maneuvers and adenosine in the treatment of PSVT through an integrative literature review. The search was conducted in the PubMed/MEDLINE, SciELO, and ScienceDirect databases, considering studies published between 2015 and 2025, using controlled descriptors and free terms in combination. Randomized clinical trials, systematic reviews, meta-analyses, and clinical guidelines addressing the management of PSVT were included. The results demonstrated that vagal maneuvers present variable efficacy, generally with success rates below 50%, whereas adenosine showed reversal rates above 80–90%. The modified Valsalva maneuver showed higher effectiveness compared to the standard technique, although still inferior to adenosine. It is concluded that, although vagal maneuvers are recommended as first-line therapy due to their safety and ease of application, adenosine stands out as the most effective strategy for restoring sinus rhythm and should be used after the failure of non-pharmacological interventions.