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HWN Suggests

Enhance the valsalva to (actually) terminate SVT

My initial treatment for stable SVT is now the modified Vasalva maneuver. We don’t have a manometer to ensure a measurable 40 mm Hg Valsalva strain, but a 10-ml syringe blown to just move the plunger generates similar pressures. I have the patient blow on a 10-ml syringe for 15 seconds, then lay them supine and raise their legs in the air for 15 seconds. I’ve successfully cardioverted more than one-third of my SVT patients using this technique. This intervention is free, safe, effective, does not require an intravenous, and can be taught to patients. There are very few treatments in medicine that are free, safe, and effective

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Articles of Interest

Modified Valsalva Maneuver Better Way to Manage Supraventricular Tachycardia

In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain should be considered as a routine first treatment, and can be taught to patients.

Modified Valsalva Maneuver for SVT

In the REVERT Trial the standard technique returned 17% of patients to sinus rhythm, whereas the modified technique returned 43% of patients to sinus rhythm — more than doubling the effectiveness.

Modified Valsalva maneuver in the treatment of SVT – REVERT Trial

Supraventricular tachycardias (SVT) is a common presentation to the emergency room, and most patients will require treatment with adenosine or electrical cardioversion, as vagal maneuvers are less than 20% of the time in clinical practice. Adenosine and electrical cardioversion both require additional hospital resources, and adenosine is poorly tolerated by patients. The REVERT trial published in 2015 in the Lancet by Appelboam et al. proposed a modified Valsalva maneuver in the treatment of SVT. The study was a multicentre randomized control trial in England involving 433 patients with stable SVT. According to an intention to treat analysis, the authors found a 43% success rate of conversion to sinus rhythm with the modified Valsalva maneuver compared to 17% with standard Valsalva. No significant dangerous adverse effects occurred in this study.

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

Vagal maneuvers are recommended as a first-line modality for terminating supraventricular tachycardia (SVT) in the emergency department (ED) with the standard valsalva maneuver (SVM) being most commonly used]. Despite the wide adoption of the SVM in adults presenting with SVT, the efficacy as a sole method in restoring sinus rhythm in such patients is less than 25%.

Slow down, you’re going too fast: SVT and The Modified Valsalva Maneuver

Vagal maneuvers, or vagals, as we like to call them, are the first line treatment for terminating supraventricular tachycardia (SVT) in the patient who is physiologically stable, and able to follow commands.

The effectiveness of the Valsalva Manoeuvre for stopping an abnormal heart rhythm

We did not find sufficient evidence to support or refute the effectiveness of VM for termination of SVT.

The Modified Valsalva Maneuver: Head Down, Legs Up

In patients with hemodynamically stable SVT the modified Valsalva maneuver should be the first line treatment as it is more effective than standard treatment in converting patients to NSR. It is simple, costs nothing, has similar adverse events, and similar time spent in the ED as standard Valsalva maneuver.