Termination of paroxysmal supraventricular tachycardia by intranasal swab insertion

Am J Emerg Med. 2023 Oct:72:222.e3-222.e4. doi: 10.1016/j.ajem.2023.08.002. Epub 2023 Aug 2.

Abstract

Paroxysmal supraventricular tachycardia (SVT) is a common emergency department presentation. Vagal maneuvers are commonly tried to terminate SVT but are often unsuccessful in terminating the dysrhythmia. The use of adenosine, while often successful, is associated with a number of side effects and is often disliked by patients with recurrent episodes of SVT. We report on a 44-year-old woman with a past medical history of SVT who presented to the emergency department (ED) due to a recurrence of her SVT. The patient had no intravenous access and preferred not to receive adenosine. The patient received intranasal stimulation with a nasopharyngeal swab used for COVID-19 testing for 5-10 s. After less than 10 s, the patient converted to a sinus rhythm. She was successfully discharged from the ED after 1 h of observation and no recurrence of her SVT.

Keywords: Nasopharyngeal swab; Suprventricular tachycardia; Vagal stimulation.

Publication types

  • Case Reports

MeSH terms

  • Adenosine / therapeutic use
  • Adult
  • COVID-19 Testing
  • COVID-19*
  • Female
  • Humans
  • Tachycardia, Paroxysmal* / diagnosis
  • Tachycardia, Paroxysmal* / drug therapy
  • Tachycardia, Supraventricular* / drug therapy
  • Tachycardia, Ventricular* / drug therapy

Substances

  • Adenosine