Background: The valsalva maneuver (VM) is safe, guideline-recommended first line emergency treatment for supraventricular tachycardia (SVT), however it is performed inconsistently with low success rate. in addition the effect of patient repositioning during VM has not been well studied.
Purpose: To evaluate the effectiveness of modified VM in treatment of SVT among adult patients presenting to ER.
Methods: A randomized control trial enrolling sixty patients presenting to ER with SVT (excluding AF and atrial flutter). two groups; standard VM group (30 patients, group A) and modified VM (30 patients, group B). A standard strain against the rubber tube of sphygmomanometer to generate a pressure about 40 mmHg used to ensure that the VM other than the change in position was the same for both groups. in group A; the patient sit at 45 degrees and exhale into the tube for 1 minute. in group B; the patient sit at 45 degrees and exhale forcefully into the tube for 15 seconds, followed by supine repositioning and passive leg raising to 45 degrees for 15 seconds, then the patient returned to the semi-recumbent position for 30 seconds before reassessment of cardiac rhythm. If patient didn't restore sinus rhythm after one minute of VM, I.V verapamil was given.
Results: There was no statistical significant difference regarding baseline characteristics (age, sex, baseline heart rate or blood pressure or serum K level) between both groups. Thirty-eight (63%) were women. In group B, fourteen patients (46.7%) of 30 participants versus only six patients (20%) in group A achieved the primary outcome of sinus rhythm at 1 minute of VM (p value = 0.02). Regarding secondary outcomes; the use of emergency drugs for SVT termination (i.e calcium channel blocker), the requirement for verapamil after VM was significantly fewer in group B compared with group A (53% vs 80%, p value = 0.01).
Conclusion: A simple, cost-free, safe postural modification to the standard VM is interestingly effective, returning nearly half (47%) of patients presenting with SVT to sinus rhythm.