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Identification of the optimum vagal manoeuvre technique for maximising vagal tone
  1. Gavin Smith1,
  2. Alicia Broek2,
  3. David McD Taylor3,
  4. Amee Morgans4,
  5. Peter Cameron5
  1. 1Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing, and Health Sciences, Alfred Centre, Monash University, Melbourne, Australia
  2. 2Ambulance Victoria, Doncaster, Victoria, Australia
  3. 3Austin Health, Heidelberg, Victoria, Australia
  4. 4Monash University, Doncaster, Victoria, Australia
  5. 5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Gavin Smith, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Monash University, Nursing, and Health Sciences, Alfred Centre, 99 Commercial Road, Melbourne 3004, Australia; gavin.smith{at}


Objectives This study sought to determine the most effective technique for Valsalva Manoeuvre (VM) and Human Dive Reflex Manoeuvre (HDR) generation of vagal tone.

Methods We conducted a repeated-measures trial of healthy adult volunteers from a university campus, aged 18–56 years, in sinus rhythm. Participants were randomised to VM (in supine or Trendelenberg postures) and HDR (supine or sitting postures) sequentially. Participants performed three trials of each technique, in random order, with a continuous ECG recording. Single-blinded analysis of ECG data was conducted. Mean differences between premanoeuvre and postmanoeuvre R-R intervals and heart rates were calculated for each posture within and between vagal manoeuvres.

Results Seventy-two participants were enrolled. The difference between VM (supine) and VM (Trendelenberg) was not significant at 0.008 s (−0.023 to 0.038). The difference in mean R-R intervals for HDR (supine) was greater than HDR (sitting) 0.062 (0.031 to 0.093), although this significance was not reflected in a heart-rate change of −0.87 (−3.00 to 1.26). VM supine generated greatest overall mean R-R interval difference, while HDR (sitting) provided the smallest change in R-R interval. The VM (supine) provided a significant maximum effectiveness over the HDR (supine) of 0.102 s (0.071 to 0.132).

Conclusions This study demonstrates that VM (supine) generates the greatest vagal tone producing the largest transient heart rate decrease in healthy volunteers. No advantage was identified in Trendelenberg posturing for the VM in this study. These results may assist in the standardisation of vagal manoeuvre technique for the range of therapeutic and diagnostic applications.

  • Research, Clinical
  • Cardiac Care, Treatment
  • Cardiac Care, Diagnosis

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