Modified Valsalva maneuver for treatment of supraventricular tachycardias: A Meta-analysis

2021 ◽  
Author(s):  
Qingsu Lan ◽  
Bing Han ◽  
Fengchao Wu ◽  
Yu Peng ◽  
Zheng Zhang
Keyword(s):  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Supraventricular Tachycardias

Eustachian Tube Balloon Dilation: A Systematic Review and Meta-analysis of Treatment Outcomes

2020 ◽  
Vol 163 (5) ◽  
pp. 870-882
Author(s):  
Michael H. Froehlich ◽  
Phong T. Le ◽  
Shaun A. Nguyen ◽  
Theodore R. McRackan ◽  
Habib G. Rizk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Eustachian Tube Dysfunction ◽  
Significant Difference ◽  
Tube Dysfunction ◽  
Outcome Metrics

Objective To examine the effectiveness of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction. Data Sources PubMed, Scopus, and Google Scholar. Review Methods A systematic review of eustachian tube balloon dilation for the treatment of eustachian tube dysfunction was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify randomized control trials and prospective and retrospective studies published prior to January 31, 2019. Meta-analysis of proportions evaluated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ7) scores, tympanometry, otoscopy findings, and the ability to perform a Valsalva maneuver. Results The systematic review identified 35 studies. Twelve studies met inclusion for meta-analysis (448 patients). Mean ETDQ7 scores decreased by 2.13 from baseline to 6 weeks (95% CI, –3.02 to −1.24; P < .001). From baseline to 6 weeks, 53.0% of patients had improvement in tympanograms ( P < .001). At the long-term point (3-12 months), 50.5% of patients had improved tympanograms from baseline ( P < .001). There was no significant difference in the proportion of improved tympanograms at 6 weeks compared to long term ( P = .535). Normal otoscopy exams at baseline increased by 30.0% at 6 weeks ( P < .001) and 55.4% in the long term ( P < .001). There was a 67.8% increase in proportion of patients able to perform a Valsalva maneuver in the long term compared to baseline ( P < .001). Conclusion Eustachian tube balloon dilation appears to be associated with improvement in subjective and objective treatment outcome metrics. The improvement appears stable at 3 to 12 months after dilation. Patients with eustachian tube dysfunction are likely to benefit from balloon dilation, particularly those with medication-refractory disease.

Comparison of Balloon Dilation and Laser Eustachian Tuboplasty in Patients with Eustachian Tube Dysfunction: A Meta-analysis

2018 ◽  
Vol 158 (4) ◽  
pp. 617-626 ◽  
Author(s):  
Tang-Chuan Wang ◽  
Chia-Der Lin ◽  
Tzu-Ching Shih ◽  
Hsiung-Kwang Chung ◽  
Ching-Yuang Wang ◽  
...  
Keyword(s):  
Eustachian Tube ◽  
Balloon Dilatation ◽  
Event Rate ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Outcome Data ◽  
Eustachian Tube Dysfunction ◽  
Improvement Rate ◽  
Tube Dysfunction

Objective We aimed to perform a meta-analysis examining balloon dilatation and laser tuboplasty for the treatment of eustachian tube dysfunction (ETD). Data Sources PubMed, Cochrane, and Embase search up to April 18, 2016, with the following keywords: eustachian, middle-ear, eustachian tuboplasty, balloon tuboplasty, laser tuboplasty, laser dilatation, and balloon dilatation. Review Methods Randomized controlled trials and prospective, retrospective, and 1-arm studies of patients with ETD treated with balloon dilatation or laser tuboplasty were included. Outcome measures were improvement of eustachian tube score (ETS) and tympanometry and Valsalva maneuver results. Results Two retrospective and 11 prospective studies were included (1063 patients; 942 treated with balloon and 121 with laser tuboplasty). Balloon tuboplasty resulted in a significant improvement of ETS (pooled standardized mean difference [SMD], 0.94; 95% confidence interval [CI], 0.23-1.66; P = .009) and, compared with laser tuboplasty, a greater tympanometry improvement rate (pooled event rate = 73% vs 13%; P = .001). Valsalva maneuver improvement rate was not different between the group results (pooled event rate = 67% vs 50%; P = .472). The maximum number of studies that provided outcome data for any one measure was only 4, and sensitivity analysis indicated ETS results may have been overly influenced by 2 studies. No balloon tuboplasty studies reported ETS data, preventing comparison between the 2 procedures. Conclusion Both procedures can improve symptoms of ETD; however, because of the limited numbers of studies reporting data of the outcomes of interest, it remains unclear if one procedure provides greater benefits.

scholarly journals Valsalva maneuver techniques for supraventricular tachycardias: Which and how?

2017 ◽  
Vol 24 (6) ◽  
pp. 298-302
Author(s):  
Salih Ekinci ◽  
Gökçe Akgül ◽  
Eda Arş ◽  
Alp Aydin ◽  
Ekrem Musalar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Repeated Measures ◽  
Valsalva Maneuver ◽  
Study Objective ◽  
T Wave ◽  
Wave Inversion ◽  
Heart Rate Decrease ◽  
Significant Difference ◽  
Supraventricular Tachycardias ◽  
Adult Volunteers

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.

scholarly journals Morphometric Features of Patent Foramen Ovale as a Risk Factor of Cerebrovascular Accidents: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 49 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Mateusz K. Hołda ◽  
Mateusz Koziej
Keyword(s):  
Systematic Review ◽  
Cerebrovascular Accident ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Foramen Ovale ◽  
Cerebrovascular Accidents ◽  
Morphometric Features ◽  
Group 2 ◽  
Group 1

Introduction: It is still disputable whether specific morphometric features of the patent foramen ovale (PFO) may stratify patients by the related probability that a discovered PFO is incidental or stroke related. Objective: We aimed to determine whether certain morphometrical characteristics of PFO are associated with an increased risk of cerebrovascular accidents, using a meta-analytical approach. Methods: We performed a systematic review of electronic databases for studies that compared morphometric parameters of PFO assessed by transesophageal echocardiography (TEE) in subjects with cryptogenic cerebrovascular accidents (Group 1) and control (Group 2). Data were extracted and pooled into a meta-analysis. Results: A total of 895 patients with PFO were reported (Group 1: 493, Group 2: 402). No difference was found in the PFO channel length (Group 1: 10.8 [8.6–12.9] mm vs. Group 2: 10.4 [9.1–11.7] mm), as well as in PFO height measured at rest (Group 1: 2.4 [1.5–3.3] mm vs. Group 2: 1.8 [1.4–2.2] mm). The PFO height measured during a Valsalva maneuver was larger in Group 1 (3.5 [2.8–4.1] mm) than in Group 2 (1.7 [1.2–2.2] mm). Also, the septal excursion distance was found to be larger in Group 1 (6.4 [5.1–7.8] mm) than in Group 2 (3.1 [1.8–4.4] mm). The risk of cerebrovascular accident was higher in patients with PFO and concomitant septal aneurysm (OR 4.00; 95% CI 2.63–6.09; p < 0.001) and with large right-to-left shunt PFO (OR 3.81; 95% CI 2.21–6.55; p < 0.001), no such relationship was found for the presence of a Eustachian valve or Chiari’s network (OR 1.90; 95% CI 0.90–4.05; p = 0.094). Conclusions: The TEE may help in identifying PFO that are of high risk of cerebrovascular accident. Greater PFO height during a Valsalva maneuver, larger septal excursion distance, concomitant atrial septal aneurysm, and large right-to-left shunt are associated with stroke-related PFOs.

scholarly journals Leg Lift Valsalva Maneuver for Treatment of Supraventricular Tachycardias

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 235-237 ◽  
Author(s):  
Allison Michaud ◽  
Eddy Lang
Keyword(s):  
Randomised Controlled Trial ◽  
Sinus Rhythm ◽  
Supraventricular Tachycardia ◽  
Emergency Treatment ◽  
Valsalva Maneuver ◽  
Controlled Trial ◽  
Valsalva Manoeuvre ◽  
Clinical Question ◽  
Randomised Controlled ◽  
Supraventricular Tachycardias

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.

scholarly journals Transcutaneous Laryngeal Ultrasound for Vocal Cord Paralysis Assessment in Patients Undergoing Thyroid and Parathyroid Surgery—A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (22) ◽  
pp. 5393
Author(s):  
Agastya Patel ◽  
Piotr Spychalski ◽  
Aleksander Aszkiełowicz ◽  
Bogusław Mikaszewski ◽  
Jarek Kobiela
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Vocal Cord ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
High Sensitivity ◽  
Cochrane Library ◽  
Forest Plot ◽  
Parathyroid Surgery ◽  
Laryngoscopic Examination

Recurrent laryngeal nerve injury is an important complication following thyroid and parathyroid surgery. Recently, Transcutaneous laryngeal ultrasound (TLUSG) has emerged as a non-invasive alternative to laryngoscopic examination for vocal cord (VC) assessment. The aim of the systematic review and meta-analysis was to determine its diagnostic accuracy in reference to laryngoscopy. It was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Scopus, Cochrane library and Web of Science databases were searched to identify relevant articles. Sixteen studies were included in the review. Pooled diagnostic accuracy was calculated based on weighted arithmetic mean and plotting forest plot. The pooled visualization rate was 86.28% and 94.13% preoperatively and postoperatively, respectively. The respective pooled sensitivity and specificity was 78.48% and 98.28%, and 83.96% (CI 95%: 77.24–88.50%) and 96.15% (CI 95%: 95.24–96.88%). The diagnostic accuracy improved if transverse and lateral approaches, and valsalva maneuver were utilized. Male gender and older age were the most crucial risk factors for VC non-visualization. TLUSG is an efficacious screening tool for vocal cord palsy due to its high sensitivity. It is likely to prevent unnecessary laryngoscopic examination in around 80% of patients, with the potential for becoming a gold standard for specific (female/young) patient cohort through assimilative modifications use, increasing expertise and development of objective measurements in the future.

scholarly journals Modified valsalva versus standard valsalva for cardioversion of supraventricular tachycardia: systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ahmed S. Abdulhamid ◽  
Fahad Almehmadi ◽  
Abdullah A. Ghaddaf ◽  
Mohammed S. Alomari ◽  
Amin Zagzoog ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Emergency Room ◽  
Supraventricular Tachycardia ◽  
Valsalva Maneuver ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
First Line ◽  
Eligibility Criteria

Abstract Background Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in terminating SVT episodes. We aimed to compare the standard VM (SVM) to the modified valsalva maneuver (MVM). We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department. Methods In this systematic review and meta-analysis, we searched Medline/PubMed, Ovid, Web of Science, and Cochrane Central Register of Controlled trials. We included only randomized controlled trials (RCTs) that compared the modified valsalva to the standard valsalva maneuver in treating SVT. Our main outcome was the termination of SVT within 1 min. Results Four articles met the eligibility criteria of our review. Sinus rhythm was achieved 2.5 times more in the MVM group compared to the SVM group (risk ratio (RR) = 2.54, CI 1.98–3.24, P < 0.001) and thus lowered the need of intravenous SVT termination medication without any significant increase in adverse events or time spent in the emergency department. Conclusion Our review found MVM to be more effective than the SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yali Wei ◽  
Yan Meng ◽  
Na Li ◽  
Qian Wang ◽  
Liyong Chen
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acid ◽  
Meta Analysis ◽  
Chain Polyunsaturated Fatty Acid ◽  
Inflammation Markers ◽  
Pufa Supplementation ◽  
Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

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