Modified Valsalva manoeuvre effectively treats supraventricular tachycardia in adults
Courtesy by André Zimerman and Andre d’Avila, Speech-Induced Atrial Tachycardia, NEJM
Cardiac arrhythmia, specifically paroxysmal supraventricular tachycardia (SVT), accounts for a substantial proportion of emergency medical services resources utilisation. Reconversion requires increasing the atrioventricular node's refractoriness, which can be achieved by vagal manoeuvres, pharmacological agents or electrical cardioversion.
There are multiple variants of vagal manoeuvres, including the Valsalva manoeuvre (VM). While the effectiveness of the standard Valsalva manoeuvre has already been systematically reviewed, there has been no such analysis for the modified Valsalva manoeuvre.
Recently, a report published in the European Journal of Emergency Medicine has stated that modified Valsalva manoeuvre has been more effective when compared to standard Valsalva manoeuvre in treating patients with supraventricular tachycardia.
Lodewyckx, Eric and colleagues from the Department of PXL-Healthcare, PXL University of Applied Sciences and Arts compared the effectiveness of the modified Valsalva manoeuvre versus the standard Valsalva manoeuvre in restoring the normal sinus rhythm in adult patients with supraventricular tachycardia.
The primary outcome was the reconversion to a sinus rhythm. Secondary outcomes included medication use, adverse events, length of stay in the emergency department and hospital admission.
Five randomised controlled trials were included, with a combined total of 1181 participants. The meta-analysis demonstrated a significantly higher success rate for reconversion to sinus rhythm when using the modified Valsalva manoeuvre compared to the standard Valsalva manoeuvre in patients with an supraventricular tachycardia. More adverse events were reported in the modified Valsalva manoeuvre group, although this difference is NS.
The available evidence suggests that medication use was lower in the modified Valsalva manoeuvre group than the standard Valsalva manoeuvre group. However, medication use could not be generalised across the different studies.
None of the included studies showed a significant difference in length of stay in the emergency department. Only one study reported on hospital admission, with no significant difference between the two groups.
The authors concluded that the available evidence is highly suggestive to support the use of the modified Valsalva manoeuvre compared to the standard Valsalva manoeuvre in the treatment of adult patients with supraventricular tachycardia.
Furthermore, meta-analysis showed a higher success rate, required less medication use, and resulted in an equal number of adverse events. However, these results cannot be regarded as definitive in the absence of higher-quality studies.
doi: 10.1097/MEJ.0000000000000862
