Modified Valsalva Maneuver Shows Higher Heart Rhythm Restoration Rate in PSVT, AIIMS Study Finds
A recent randomized controlled trial published in the Indian Heart Journal in February 2026 shows that adding a simple postural adjustment to a vagal maneuver restored normal heart rhythm without medication in over a quarter of emergency cardiac patients. The modified technique achieved a 26.3% (10/38) conversion rate versus 16.2% (6/37) with standard strain (odds ratio 0.54; 95% confidence interval 0.17–1.68; p > 0.05).
While vagal maneuvers like the traditional Valsalva maneuver (VM) serve as first-line non-pharmacological therapy for paroxysmal supraventricular tachycardia (PSVT), success rates remain low (5–20%), prompting the Postural Modification to the Standard Valsalva Manoeuvre for Emergency Treatment of Supraventricular Tachycardias (REVERT) trial to demonstrate improved conversion; however, sparse real-world data persist in tertiary emergency settings in India. To bridge this gap, Dr. Sheena Arora, Dr. Akshay Kumar, and colleagues from All India Institute of Medical Sciences (AIIMS), New Delhi, conducted a randomized trial evaluating the efficacy and safety of the modified Valsalva maneuver (mVM) versus the standard Valsalva maneuver (sVM) in acute emergency presentations.
Therefore, the randomized controlled trial evaluated 75 hemodynamically stable emergency department patients with paroxysmal supraventricular tachycardia, comparing a modified postural Valsalva technique (n=38) against standard strain (n=37). The primary outcome was electrocardiogram-confirmed conversion to normal sinus rhythm at one minute, alongside secondary measures of sustained conversion, rescue therapy needs, and safety.
Key Clinical Findings of the Study Include:
- Enhanced Initial Cardioversion: The trial observed a higher 1-minute NSR conversion rate of 26.3% (10/38) with mVM compared to 16.2% (6/37) with sVM (odds ratio 0.54; 95% confidence interval 0.17–1.68; p = 0.286).
- Superior Rhythm Retention: The investigation demonstrated that among initial responders, NSR was maintained at 5 minutes in 90.0% (9/10) of mVM patients versus 66.7% (4/6) in sVM controls (p = 0.518).
- Reduced Pharmacological Need: The research noted that rescue antiarrhythmic medication was required in fewer mVM participants (76.3%, 29/38) than sVM controls (89.2%, 33/37; p = 0.141).
- Flawless Safety Record: The study recorded zero serious adverse events or deaths, confirming both non-invasive techniques are exceptionally safe in emergency management.
The results suggest that while the modified Valsalva maneuver achieved a higher numerical cardioversion success rate of 26.3% compared to 16.2% for the standard technique in emergency PSVT, this difference did not achieve statistical significance (p > 0.05). Overall, both vagal techniques proved safe and well-tolerated, though larger trials are necessary to verify definitive superiority.
Thus, the study concludes clinicians may consider employing the modified postural maneuver as a safe initial non-invasive option in emergency care, as its higher conversion trend and excellent safety profile offer potential clinical benefit despite unproven statistical superiority.
While the study was constrained by a single-center design and a reduced sample size of 75 participants due to pandemic-related recruitment interruptions, these findings highlight the necessity for larger multicentric investigations to evaluate potential confounders such as structural heart disease and tachycardia subtypes.
Reference
Arora S, Aggarwal P, Kumar A, Jamshed N, Mishra PR, Ekka M, Sahu AK. Modified Valsalva versus standard Valsalva manoeuvre in patients with paroxysmal supraventricular tachycardia in the emergency department: A randomised trial. Indian Heart Journal. 2026;78(2):173–178.
