Management of supraventricular tachycardia using the Valsalva manoeuvre

2012 ◽  
Vol 19 (6) ◽  
pp. 346-352 ◽  
Author(s):  
Gavin Smith
Keyword(s):  
Supraventricular Tachycardia ◽  
Valsalva Manoeuvre

The effectiveness of the modified Valsalva Manoeuvre for reversion of supraventricular tachycardia

2020 ◽  
Author(s):  
Satoshi Yoshimura ◽  
Shunsuke Kimata ◽  
Ethan Sahker ◽  
Takuya Taniguchi ◽  
Norio Watanabe
Keyword(s):  
Supraventricular Tachycardia ◽  
Valsalva Manoeuvre

scholarly journals Randomised Controlled Trial Assessing Head Down Deep Breathing Method Versus Modified Valsalva Manoeuvre for Treatment of Supraventricular Tachycardia in the Emergency Department

2021 ◽  
Vol 22 (4) ◽  
pp. 820-826
Author(s):  
Hoon Chin Lim ◽  
Yi-En Clara Seah ◽  
Arshad Iqbal ◽  
Vern Hsen Tan ◽  
Shieh Mei Lai
Keyword(s):  
Emergency Department ◽  
Randomised Controlled Trial ◽  
Adverse Effects ◽  
Sinus Rhythm ◽  
Supraventricular Tachycardia ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Valsalva Manoeuvre ◽  
Deep Breathing ◽  
Randomised Controlled

Introduction: Supraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM). Methods: We conducted a randomised controlled trial at an acute hospital ED. Patients presenting with SVT were randomly assigned to HDDB or modified VM in a 1:1 ratio. A block randomisation sequence was prepared by an independent biostatistician, and then serially numbered, opaque, sealed envelopes were opened just before the intervention. Patients and caregivers were not blinded. Primary outcome was cardioversion to sinus rhythm. Secondary outcome(s) included adverse effects/complications of each technique. Results: A total of 41 patients were randomised between 1 August, 2018–1 February, 2020 (20 HDDB and 21 modified VM). Amongst the 41 patients, three spontaneously cardioverted to sinus rhythm before receiving the allocated treatment and were excluded. Cardioversion was achieved in six patients (31.6%) and seven patients (36.8%) with HDDB and modified VM, respectively (odds ratio1.26, 95% confidence interval, 0.33, 4.84, P = 0.733) . Seventeen (89.5%) patients in the HDDB group and 14 (73.7%) from the modified VM group did not encounter any adverse effects. No major adverse cardiovascular events were recorded. Conclusion: Both the head down deep breathing technique and the modified Valsalva manoeuvre appear safe and effective in cardioverting patients with SVT in the ED.

scholarly journals The life and work of Antonio Maria Valsalva (1666–1723) – Popping ears and tingling tongues

2017 ◽  
Vol 19 (2) ◽  
pp. 161-163 ◽  
Author(s):  
Nathan Jacobs ◽  
Michele Bossy ◽  
Amish Patel
Keyword(s):  
High Altitude ◽  
Supraventricular Tachycardia ◽  
Eustachian Tube ◽  
Upper Airway ◽  
Valsalva Manoeuvre ◽  
Vocal Cords ◽  
Accessory Muscles

The Valsalva manoeuvre is the increase in intra-thoracic pressure achieved by attempted expiration against a closed upper airway. The contraction of abdominal and other accessory muscles of respiration attempt to decrease the intra-thoracic volume, whilst the airway is closed either by the forceful apposition of the vocal cords or else by firmly closing the lips and sealing off the nose (e.g. by pinching it). Valsalva described this manoeuver as a way of checking the patency of the Eustachian tube. However, it has found other uses, including as a way to terminate episodes of supraventricular tachycardia and stopping ear popping-pain on high altitude flights. But who was Valsalva?

Valsalva manoeuvre for supraventricular tachycardia in transplanted heart recipient

The Lancet ◽  
1995 ◽  
Vol 346 (8976) ◽  
pp. 713 ◽  
Author(s):  
P. Ambrosi ◽  
G. Habib ◽  
B. Kreitmann ◽  
G. Faugère ◽  
D. Métras
Keyword(s):  
Supraventricular Tachycardia ◽  
Valsalva Manoeuvre

scholarly journals PP23 Evaluation of pre-hospital use of a valsalva assist device (VAD) in the Emergency treatment of supraventricular tachycardia (SVT). A randomised controlled feasibility trial [EVADE]

2019 ◽  
Vol 36 (10) ◽  
pp. e10.3-e11
Author(s):  
Jonathan Green ◽  
Paul Ewings ◽  
Andy Appelboam
Keyword(s):  
Supraventricular Tachycardia ◽  
Presentation Rate ◽  
Heart Rhythm ◽  
Feasibility Trial ◽  
Occurrence Rate ◽  
Valsalva Manoeuvre ◽  
Data Sets ◽  
Assist Device ◽  
Rhythm Disorder ◽  
Randomised Controlled

BackgroundSupraventricular tachycardia (SVT) is a common heart rhythm disorder. The Valsalva Manoeuvre (VM) is a safe, internationally recommended, initial treatment, but has a low success rate in normal practice. Recent studies have shown much better cardioversion rates, approaching 50%, can be achieved using a postural modification (the modified VM) and a manometer controlled 40 mmHg strain. Successful cardioversion could avoid hospital conveyance and unpleasant treatments, such as adenosine. Routine use of a manometer is not practical out of hospital. Blowing on an empty syringe has been suggested as an alternative but is unreliable in providing correct and consistent pressures. A Valsalva Assist Device (VAD), designed to provide a 40 mmHg strain resistance has been developed. It is small, portable, can be packaged with instructions for the modified VM and if successful, may be left with the patient.MethodsWe conducted a pragmatic, randomised controlled feasibility trial, comparing VAD versus standard practice delivered VMs. All other aspects of care were according to SWASFT guidelines. Participants were followed up to ask their views on trial procedures.Interim results (month 5 of 6)23 volunteer Station Leads recruited 22 Study Clinicians from 27 ambulance stations. 29 patients were enrolled over 5 months, 19 in the last 2 months (the first 3 months included steady recruitment and setup). The later enrolment rate extrapolates to a presentation rate of approximately 220 eligible patients to SWASFT each year. Complete data sets were available in 100% of participants. When followed up, participants reported verbal consent to be widely acceptable, although SVT symptoms were substantially distracting for many during this process.ConclusionOur experience of recruitment and data collection suggest a definitive trial, using similar methodology, is possible, but the low occurrence rate may challenge feasibility. Consent taking methods may require refinement for a larger trial.

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