Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial

Çorbacıoğlu, Şeref Kerem; Akıncı, Emine; Çevik, Yunsur; Aytar, Halit; Öncül, Mehmet; Akkan, Sedat; Uzunosmanoğlu, Hüseyin

doi:10.1016/j.ajem.2017.05.034

Cited by 31 publications

(31 citation statements)

References 17 publications

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“…Although straining in upright postures is in theory associated with a greater drop in BP and an increased risk of syncope during straining,7 this complication was not seen in our study which used a controlled and defined strain and is consistent with our experience of the modified VM in clinical practice and trials. There were no serious adverse events and the number of non-serious adverse events was similar between the two different posture groups.…”

Section: Discussionsupporting

confidence: 87%

Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers

et al. 2018

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BackgroundThe Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation.MethodsWe conducted a repeated measures randomised trial of four VMs (two supine VM and two modified VMs), in healthy adult volunteers, with strains delivered using an adapted sphygmomanometer (manometer) or a VAD. Changes in HR, pressure and duration of strain and adverse events were monitored and compared between the techniques and devices. The trial was approved by the University of Exeter Medical School Research ethics committee.Results75 healthy participants aged 19–55 years were recruited over a 4-month period. A mixed-effects linear regression showed the modified VM resulted in a 3.8 beats per min (bpm) greater drop in HR compared with the supine VM (p=0.002, 95% CI 2.2 to 5.4). VM strains produced by the VAD were of a similar pressure but of slightly shorter duration and resulted in a 1.9 bpm smaller drop in HR compared with the manometer (p=0.01, 95% CI 0.4 to 3.4). There were no differences in adverse events.ConclusionsModified VM was associated with a greater drop in HR than a supine VM with no increase in adverse events in healthy volunteers. The VAD can be used to safely generate the recommended VM strain pressure, but produced a smaller drop in HR compared with a manometer and requires modification to enable the recommended strain duration to be achieved consistently.Trial registration numberNCT03298880.

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Section: Discussionsupporting

confidence: 87%

Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers

et al. 2018

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“…Çorbacıoğlu et al 30 Sampling: 56 patients Methodology: patients were divided into two groups, those who received the first standard VM treatment (expiration against resistance for 15 seconds) and those who received MVM (lower limb inclination after 45º after expiration). The maneuvers were repeated up to 3 times in which the patient did not convert to sinus rhythm.…”

Section: Author Methodology and Sampling Resultsmentioning

confidence: 99%

“…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: 98%

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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“…21,22 Valsalva maneuver is the most effective of vagal maneuvers, terminating tachycardia in up to 43% of women with a modification in which the maneuver is performed seated, followed by an abrupt move to the supine position with legs elevated. 23 Other effective vagal maneuvers include induction of the diving reflex with application of an ice-cold towel to the face, or immersion of the face in cold water. 22,24 Adenosine, administered in doses of 6-24 mg pushed rapidly via proximal intravenous line, is effective at terminating maternal SVT, with success rates well over 80%.…”

Section: Av Nodal Reentrant Tachycardia and Av Reentrant Tachycardiamentioning

confidence: 99%

Management of tachyarrhythmias in pregnancy – A review

Kugamoorthy

Spears

2020

Obstet Med

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Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial

Cited by 31 publications

References 17 publications

Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers

Testing of a novel Valsalva Assist Device with supine and modified positions in healthy volunteers

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

Management of tachyarrhythmias in pregnancy – A review

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