Key Results: There were 428 adult patients included in the study. The mean age was in the mid-50s, approximately 60 percent were female, and about half had a history of SVT.
The modified Valsalva maneuver resulted in an increased frequency of conversion out of SVT to sinus rhythm compared to the standard Valsalva maneuver. The adjusted odds ratio = 3.7 (95 percent CI, 3.3–5.8; P<0.0001). Number needed to treat (NNT) = 4 (95 percent CI, 3–7).
Primary Outcome: Return to sinus rhythm at one minute:
Modified 43 percent versus standard 17 percent, NNT = 4
There was less use of adenosine and anti-dysrhythmic drugs. There was no difference in length of stay in the ED, discharge home, or adverse events.
The modified Valsalva maneuver resulted in an increased frequency of conversion out of SVT to sinus rhythm compared to the standard Valsalva maneuver.
EBM Commentary:
- This pragmatic study was very well done and addressed a common condition presenting to the ED. The postural modification of the standard Valsalva maneuver represents an inexpensive, well-tolerated treatment option with a NNT of 4.
- Blinding was a potential limitation in this study. The authors tried hard to minimize this type of bias. It was not possible to blind the providers to the treatment group. However, the patients were not aware of which treatment was the modified technique. The independent cardiologist who retrospectively assessed the ECGs was blinded to group allocation. If there were disagreements about ECG interpretation between the unblinded treating physician and the blinded cardiologist, an independent electrophysiologist, also blinded, arbitrated.
Bottom Line: To REVERT your next stable patient with SVT to a sinus rhythm, consider a postural modification of the standard Valsalva maneuver.
Case Resolution: You use the modified Valsalva maneuver and successfully convert him to a sinus rhythm.
Thank you to Dr. Robert Edmonds, a third-year emergency medicine resident at the University of Missouri at Kansas City, for his help on this review.
Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.
References
- Smith GD, Dyson K, Taylor D, et al. Effectiveness of the Valsalva manoeuvre for reversion of supraventricular tachycardia. Cochrane Database Syst Rev. 2013 Mar 28;3:CD009502.
Pages: 1 2 3 | Single Page
2 Responses to “Modified Valsalva Maneuver Better Way to Manage Supraventricular Tachycardia”
June 19, 2016
Chuck PilcherI’ve found occasional success with an even more aggressive “modification” of the Valsalva maneuver.
The goal of the maneuver is to raise pressure on the carotid baroreceptors, right? So if the “regular” Valsalva maneuver hasn’t worked, I’ve had (usually young, athletic) patients) lie prone on the gurney, hang their head over the end of that gurney so they are at a 90 degree angle head-down, take a deep breath and hold it for 15 seconds or so. It seems to work better.
May 30, 2019
joeNice article. I want to add more.
I believe A normal heart beats 60 to 100 beats per minute (bpm) but when you have SVT, your heart rate may be sustained way above 100 bpm, sometimes up to 180 or 200bpm, for several minutes or hours. You may feel that you have a racing heartbeat, which can be described as palpitations.