A modified Valsalva manoeuvre results in greater termination of supraventricular tachycardia than standard Valsalva manoeuvre

Smith, Gavin

doi:10.1136/ebmed-2015-110357

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…1). The full texts of the remaining 11 studies were retrieved for evaluation; of which four studies were excluded due to study design [12,[17][18][19], and two studies [6,20] were excluded because they did not compare the modified VM versus the standard VM. A total of five studies were included in the systematic review.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of the modified Valsalva manoeuvre in adults with supraventricular tachycardia: a systematic review and meta-analysis

Lodewyckx

Bergs

2021

European Journal of Emergency Medicine

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Background and importance 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 VM has already been systematically reviewed, there has been no such analysis for the modified VM. Objective(s) Compare the effectiveness of the modified VM versus the standard VM in restoring the normal sinus rhythm in adult patients with supraventricular tachycardia. Design Systematic review with meta-analysis of published randomised controlled trials. Outcome measures 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. Main results 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 VM compared to the standard VM in patients with an SVT (odds ratio = 4.36; 95% confidence interval, 3.30–5.76; P < 0.001). More adverse events were reported in the modified VM group, although this difference is NS (risk ratio = 1.48; 95% confidence interval, 0.91–2.42; P = 0.11). The available evidence suggests that medication use was lower in the modified VM group than the standard VM 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. Conclusions The available evidence is highly suggestive to support the use of the modified VM compared to the standard VM in the treatment of adult patients with SVT. 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.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of the modified Valsalva manoeuvre in adults with supraventricular tachycardia: a systematic review and meta-analysis

Lodewyckx

Bergs

2021

European Journal of Emergency Medicine

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“…As for the expiration time, according to the studies approached, the majority used the time of 15 seconds, both for CVM and MVM. The degree of inclination, for MVM, was different in only one, with elevation of the limbs below 90°2 0 , while the others performed the maneuver at 45°2 2,24,25,30,31,33 . However, there were no significant differences in the success rates between the two angles.…”

Section: Discussionmentioning

confidence: 97%

Eficácia da manobra de Valsalva modificada como tratamento para reversão de taquicardia supraventricular: revisão sistemática

Ferreira

Fumagalli

Teixeira

2021

Rev. Med. (São Paulo)

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Introdução: a taquicardia supraventricular é uma arritmia frequente com prevalência de 2,29 a cada 1000 pessoas. Tratamentos medicamentosos e elétrico já são bem delineados em diretrizes como da American Heart Association, porém, acompanhados de risco de efeitos incomodativos ao paciente como falta de ar e sensação de compressão torácica. A estimulação não medicamentosa do nervo vago, como a manobra Valsalva convencional, apresenta pouco efeito colateral, porém, baixa eficácia com cerca de 17% de conversões. Neste cenário, um novo método de estimulação parassimpática tem sido promissor na terapia inicial não medicamentosa: a manobra de Valsalva modificada. Esta consiste na elevação dos membros inferiores após uma expiração contra resistência, visando atingir um maior grau de estimulação vagal. Objetivo: avaliar a taxa de sucesso na reversão de taquicardias supraventriculares pela manobra modificada, por análise dos resultados da execução desta manobra, bem como comparando-a com a manobra de Valsalva convencional. Metodologia: foram feitas pesquisas no banco de dados da Scielo e PubMed pelos termos “tachycardia AND modified Valsalva maneuver”. Artigos publicados 2005 a 2020 foram selecionados e passaram por uma filtragem individual de seus conteúdos (título, abstract e metodologias) buscando homogeneizar assim os resultados. Resultados e Discussão: o artigo apresentado pela Scielo não condizia com este tipo de estudo, e dentre os 29 relacionados pelo PubMed, após filtragem de tempo e critérios de análise individual, 9 trabalhos foram compilados nesta revisão, sendo que 3 fazem uma avaliação isolada da manobra modificada enquanto 6 demonstram uma comparação direta entre as manobras. Todos apontam uma maior eficácia na cardioversão da arritmia pela manobra modificada em comparação com a convencional, sendo uma média das porcentagens de resolução de 48,3% contra 19,6%, respectivamente, sem diferenças significativas nos eventos adversos. Conclusão: A manobra Valsalva modificada gerou uma maior reversão da arritmia do que aqueles que utilizaram a convencional, sem acréscimos de efeitos colaterais e expondo menor número de pacientes a terapias medicamentosas ou cardioversões elétricas.

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“…1,24 In recent years, several studies have shown that the modified Valsalva maneuver significantly improves the success rate of conversion in patients with PSVT compared with the standard Valsalva maneuver (43% vs. 17%, respectively), reducing the adverse reactions caused by drugs and electrical cardioversion. 20,[28][29][30] In 2021, Lan et al 1 performed a meta-analysis of 6 RCTs involving 1208 patients with PSVT. The authors compared the efficacy of the modified versus standard Valsalva maneuver in the treatment of PSVT.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of modified Valsalva maneuver for treatment of paroxysmal supraventricular tachycardia: a meta-analysis

Lu,

Zhu,

Gao

et al. 2024

J Int Med Res

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Objective To compare the efficacy and safety of the modified versus standard Valsalva maneuver in the treatment of paroxysmal supraventricular tachycardia (PSVT). Methods The PubMed, Embase, Web of Science, CNKI, WanFang Data, and VIP electronic databases were searched to identify studies comparing the modified and standard Valsalva maneuvers in the treatment of PSVT from database inception to 1 May 2023. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias of all included studies. Results Nineteen randomized controlled trials involving 2527 patients with PSVT were included. The overall rate of cardioversion was higher in the modified than standard Valsalva group (risk ratio [RR] = 1.80, 95% confidence interval [CI] = 1.61–2.01), as was the success rate of cardioversion after a single Valsalva maneuver (RR = 2.05, 95% CI = 1.74–2.41). There was no statistically significant difference in adverse reactions between the two groups (RR = 1.07, 95% CI = 0.82–1.38). Conclusion Current evidence suggests that the modified Valsalva maneuver can significantly improve the success rate of cardioversion in patients with PSVT without increasing adverse reactions. The modified Valsalva maneuver is therefore worth promoting and should be considered as a routine first treatment. INPLASY registration number: 2023100092

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A modified Valsalva manoeuvre results in greater termination of supraventricular tachycardia than standard Valsalva manoeuvre

Cited by 6 publications

References 5 publications

Effectiveness of the modified Valsalva manoeuvre in adults with supraventricular tachycardia: a systematic review and meta-analysis

Effectiveness of the modified Valsalva manoeuvre in adults with supraventricular tachycardia: a systematic review and meta-analysis

Eficácia da manobra de Valsalva modificada como tratamento para reversão de taquicardia supraventricular: revisão sistemática

Efficacy and safety of modified Valsalva maneuver for treatment of paroxysmal supraventricular tachycardia: a meta-analysis

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