Efficacy and economic benefits of a modified Valsalva maneuver in patients with paroxysmal supraventricular tachycardia

Wang, Wei; Jiang, Teng-Fei; Han, Wei; Jin, Lin; Zhao, Xiaojing; Guo, Ying

doi:10.12998/wjcc.v8.i23.5999

Cited by 9 publications

(17 citation statements)

References 34 publications

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“…Patient treated with MVM had higher success rates of reversion of SVT after single secession was 47.78% and after multiple secession it was 62.22%, while 15.38% and 19.78% were successful in achieving sinus rhythm after single and multiple secession of the standard method. 9,26,27 This appears to be more cost-effective and reduce the financial burden in developing countries not only on patient but also on hospital managment, as it can be adapted by patients for use at home, reduce presentations to hospital and decrease drug need and costs.…”

Section: Appelboam Et Al and Walker Et Al Have Claimedmentioning

confidence: 99%

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan

ASHRAF¹,

FATIMA²,

ASHRAF

et al. 2023

Pak J Med Sci

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Background and Objectives: The Valsalva maneuver (VM) is the most effective measure that can be carried out to treat supraventricular tachycardia (SVT). Our objective was to compare the efficacy of postural modified VM with 20 ml syringe to standard VM for the emergency treatment of SVT. Methods: This randomized control trial study was conducted at the Accident and Emergency Department, Pakistan ordinance factories hospital, Wah Cantt from July 2019 to September 2020. In the standard Valsalva group, fifty patients were placed at an angle of 45 with continuous monitoring of vitals and electrocardiogram. Patients blew into a 20ml syringe to generate 40 mmHg pressure for 15 seconds and remained in the same position for 45 seconds before a reassessment of cardiac rhythm at one-minute and three-minute intervals. In the modified Valsalva group same procedure was repeated with the other fifty patients, but immediately at the end of the strain, they were laid flat with their legs raised to 45° for 15 seconds. Participants returned to semi-recumbent position and cardiac rhythm was reassessed after 45 seconds and then at one and three minutes. Results: In the standard Valsalva maneuver (SVM)20.0% of participants versus 58% of participants in the modified Valsalva maneuvers group(MVM) reverted to sinus rhythm at one min (odds ratio or 5.52, 95% CI 2.26-13.47; p<0.001) and time of stay in the emergency room was (odds ratio or 2.39, 95% CI 1.45- 3.93; p<0.0001). Conclusion: Modified Valsalva by using a wide-bore syringe is more effective method than standard Valsalva in terminating SVT. doi: https://doi.org/10.12669/pjms.39.3.6725 How to cite this: Ashraf H, Fatima T, Ashraf I, Majeed S. Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan. Pak J Med Sci. 2023;39(3):693-697. doi: https://doi.org/10.12669/pjms.39.3.6725 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Appelboam Et Al and Walker Et Al Have Claimedmentioning

confidence: 99%

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan

ASHRAF¹,

FATIMA²,

ASHRAF

et al. 2023

Pak J Med Sci

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“…A total of 22 papers were screened for eligibility. Finally, 14 studies were enrolled for successful conversion to sinus rhythm, and 13 studies were analyzed to compare the risk of adverse events in different VagMs (5,9,10,16,(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Study Characteristicsmentioning

confidence: 99%

Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis

et al. 2022

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BackgroundVagal maneuvers (VagMs) are recommended as the first-line treatment of supraventricular tachycardia (SVT). However, the optimal type of VagMs remains unproven.AimThis study aims to compare the effectiveness and adverse events amongst VagMs on SVT via network meta-analyses (NMAs).MethodsWe systematically searched randomized controlled trials (RCTs) that involved adults with SVT and compared VagMs without language restrictions. We determined the initial and final responses of conversion rate to sinus rhythm and adverse events. Risk of bias (RoB) was appraised by Cochrane revised tool, and contribution matrix was calculated. NMAs were synthesized using frequentist random-effects model and presented as relative risk (RR) with 95% CI. The order of probability was presented as surface under the cumulative ranking curve analysis (SUCRA). Sensitivity analysis was performed using both Bayesian and frequentist approach with fixed- or random-effects models. Certainty of evidence (CoE) was rated by using the Grading of Recommendations, Assessment, Development, and Evaluations methodology.ResultsFourteen RCTs with 2,180 patients were enrolled. Small portion of mixed estimates was contributed from high overall RoB studies. Compared with carotid sinus massage (CSM), the modified Valsalva maneuver (MVM) was the most effective VagM after initial performance [SUCRA: 0.9992, RR: 5.47 (1.77–16.93)] and at the end of study [SUCRA: 1.0000, RR: 3.62 (2.04–6.39), CoE: high]. The standard VM did not elicit better conversion rate to the sinus rhythm than CSM at the initial response [SUCRA: 0.4395, RR: 1.97 (0.63–6.15)] and at the end of the study [SUCRA: 0.4795, RR: 1.64 (0.94–2.87), CoE: moderate]. The SUCRA value of CSM at the initial and final responses was the least one amongst three VagMs (0.0613 and 0.0205, respectively). Adverse events amongst three VagMs were similar (CoE: low). Sensitivity analyses yielded consistent results.ConclusionWe recommended MVM as the first choice of VagM for rhythm conversion before the pharmacological management of SVT.

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“…Characteristics of the included studies [11,[21][22][23][24] are presented in Table 1. The full extraction of the retrieved data can be found in Appendix S4, Supplemental digital content 1, http://links.lww.com/EJEM/A317.…”

Section: Included Studiesmentioning

confidence: 99%

“…Not all included studies reported all the selected secondary outcomes, for example, medication use, length of stay, adverse events and hospital admission. Two studies reported on multicentre trials [11,21], the other three studies reported on single-centre trials [22][23][24].…”

Section: Included Studiesmentioning

confidence: 99%

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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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Efficacy and economic benefits of a modified Valsalva maneuver in patients with paroxysmal supraventricular tachycardia

Cited by 9 publications

References 34 publications

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan

Effectiveness of modified Valsalva maneuver by using wide bore syringe for emergency treatment of supraventricular tachycardias: Findings from Pakistan

Comparison of Various Vagal Maneuvers for Supraventricular Tachycardia by Network Meta-Analysis

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

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