Leg Lift Valsalva Maneuver for Treatment of Supraventricular Tachycardias

Abstract

Clinical questionCan conversion to sinus rhythm for a supraventricular tachycardia be enhanced by a postural modification to the Valsalva maneuver?Article chosenAppelboam A, Reuben A, Mann C, et al. Postural modification of the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet 2015;386(10005):1747-53.1ObjectiveTo determine effectiveness of a postural modification of the Valsalva involving leg elevation and supine positioning.

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

“…Increasing evidence suggests that weaker vagal nerve stimulation significantly enhances the conduction differences in the atrioventricular junction, making it more prone to AVNRT, whereas high-intensity vagal nerve stimulation (such as carotid sinus massage and the Valsalva maneuver) significantly increases the effective refractory period of atrioventricular conduction, interrupting AVNRT and ultimately terminating SVT. 4,27 Therefore, stimulation of the vagus nerve through techniques such as the Valsalva maneuver is a recommended first-line intervention to ensure stable blood pressure, respiration, and other vital signs in patients with PSVT.…”

Reversión de taquicardia supraventricular con la maniobra de Valsalva modificada

“…-No instrumentada: se realiza una inspiración y luego se «puja» durante 10-15 segundos, con posterior expulsión brusca del aire 11 . -Modificada (MVM): se realiza la maniobra de Valsalva tradicional instrumentada e inmediatamente después se hace un cambio postural, pasando de sedestación a decúbito supino con elevación de las piernas a 45° durante 15 segundos, y luego reincorporándose a la posición original durante 45 segundos hasta ser reevaluado el nuevo trazo del electrocardiograma 12 . En 1998, Lim et al 13 compararon la efectividad de las maniobras vagales: «se estudiaron 148 casos de TSV, 62 pacientes se sometieron primero a la maniobra de Valsalva con conversión en 12 (tasa de éxito del 19.4%).…”

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

“…After this period, the patient is repositioned in the initial position and the rhythm is checked 24 . This postural change doesn't present risks and also indirectly reduces the need for antiarrhythmic medication 21 .…”