Valsalva maneuver techniques for supraventricular tachycardias: Which and how?

Abstract

Study objective: While some research has been done on Valsalva maneuvers in treating supraventricular tachycardia, there is no standardized algorithm on which technique has been the most effective for the termination of supraventricular tachycardias. In this study, we compare different Valsalva maneuver techniques in order to determine the exact technique needed for maximal vagal response. Methods: This was a repeated measures clinical study, which enlisted a sample of healthy adult volunteers. Participants performed four different Valsalva maneuver techniques (40 mm Hg-10 s, 40 mm Hg-15 s, 50 mm Hg-10 s, and 50 mm Hg-15 s) while lying in a supine position. The maneuvers were repeated three times. An electrocardiography printout was obtained during each trial, and heart rate differences between pre-maneuver and post-maneuver were measured. Results: Among the 97 volunteers who participated in the study, 7 were excluded because the target Valsalva maneuver pressures were not reached, and 1 volunteer was excluded due to T-wave inversion that developed after Valsalva maneuver. We enrolled 89 participants. There was no significant difference in the heart rate decrease among the four techniques. In addition, there was no difference between the vagal responses in terms of age, gender, and body mass index. Conclusion: This study shows that the four different Valsalva maneuver techniques were not superior to one another in terms of decreased heart rate.

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

“…that the Trendelenburg posture labelled as modified Valsalva gives a higher number of successful terminations of SVTs, so the "standard technique" is compared with different methods consisting of many different postures and durations. [21][22][23] The findings of our studies also coincide with the findings of their studies which is that the MVM is more successful than the standard Valsalva. Ferreira et al and Wheeler et al conducted studies to compare the MVM with the SVM showing that there was an increase in the rate of termination of SVT to normal sinus rhythm using the modified Valsalva just as in our studies.…”

“…In addition, there were no differences between the vagal responses in terms of age, gender, and body mass index. 21 In our study, we used the SVM in patients laying on a trolley at an angle of 45 degrees. Then the patient blew into a 20ml syringe to move the plunger to generate 40mmHg pressure instead of a sphygmomanometer for 15seconds and remained in the same position for 45 seconds before reassessment of cardiac rhythm, initially at one-min and then at threeminutes intervals, the result shows that only 4% of patients showed successful termination of SVT, which is not statistically significant.…”