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Carotid sinus massage for diagnosis and termination of supraventricular tachycardia (SVT) is still a widely used vagal manoeuvre in the AE department. However, itsefficacy is limited (termination of the SVT in approximately 20%) and carotid sinus massage may be complicated by (potentially devastating) neurologic complications in 0.2-1% of the patients. There are safer interventions without neurologic complications, such as the modified Valsalva manoeuvre (efficacy 43%) and intravenous administration of adenosine (efficacy 75%). Monitor observation of the heart rhythm is required, both for vagal manoeuvres and for adenosine administration, because of the possibility of ventricular tachycardia or ventricular fibrillation induction (incidence 0.08%). Carotid sinus massage remains an important diagnostic method in patients with unexplained syncope in whom, based on the clinical history, carotid sinus hypersensitivity is suspected. It should be avoided in patients with previous TIA or stroke within the past 3 months, or those with carotid bruits, except if carotid Doppler studies have excluded significant stenosis (≥ 70%).