A Single Center Randomized Controlled Trial Comparing Success Rates of Valsalva Versus Modified Valsalva Maneuver in Terminating Paroxysmal Supra-Ventricular Tachycardia

Sarmad Zahoor; Muhammad Ali Khawaja; Mubashar Sultan Hashmi; Hafiz Mudabbar Mahboob; Muhammad Asim Rana; Zohaib Sadiq

doi:10.70749/ijbr.v3i3.922

Authors

Sarmad Zahoor Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan.
Muhammad Ali Khawaja Department of Cardiology, Lahore Medical and Dental College (LMDC), Lahore, Pakistan.
Mubashar Sultan Hashmi Department of Critical Care, Bahria International Hospital, Lahore, Pakistan.
Hafiz Mudabbar Mahboob Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan.
Muhammad Asim Rana Department of Critical Care, Bahria International Hospital, Lahore, Pakistan.
Zohaib Sadiq Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i3.922

Keywords:

Paroxysmal Supraventricular Tachycardia, Valsalva Maneuver, Modified Valsalva, Randomized Controlled Trial

Abstract

Background: Atrial tachyarrhythmia with PSVT is a frequent clinical phenomenon presenting as palpitation and can be life threatening at times. Vagal maneuvers are initial measures that can be employed to stop PSVT, of which the Valsalva maneuver is the most frequent. In a recent past, there have been modifications of these methods to improve the effectiveness of the methods. Objective: Hence, the objective of this study is to look at the efficacy of the traditional Valsalva maneuver compared to the modified Valsalva maneuver to stop PSVT in a single-center, randomized controlled trial. Methods: Altogether, 124 patients with diagnosed PSVT were randomized to either the Valsalva group or the modified Valsalva group. The first measure of efficacy was defined as the failure termination of PSVT within 2 minutes of beginning the maneuver. The secondary measures were therefore the degree of comfort of the patient, the rate of recurrence within 24 hours, and any side effects experienced. Categorical data were compared by chi-square tests, while continuous data were compared by t-tests. Results: The Modified Valsalva group resulted in a higher success rate of 68 percent in comparison with the traditional Valsalva group, which achieved only a 48 percent success rate (p=0.02). In particular, patients in the modified group achieved higher comfort (p = 0.03) and lower frequency of recurrence within 24 hours (p = 0.04). Side effects, if any, which were negligible, were not reported in either of the groups. Conclusion: The present study shows the effectiveness of the modified technique over the traditional Valsalva maneuver in the termination of PSVT, comfort to the patient, and reduced chances of recurrence. These results reinforce the use of such modified maneuvers in clinical procedures to enhance the many patients.

Downloads

Download data is not yet available.

References

Alfehaid, A. A., Almutairi, O. T., Albloushi, M. H., Alahmad, A. A., Hasan, M. K., Alawadhi, O. F., . . . Almuhannadi, F. N. J. C. (2024). Valsalva maneuver versus carotid sinus massage for supraventricular tachycardia: a systematic review and meta-analysis of randomized controlled trials. 16(9). https://doi.org/10.7759/cureus.70064

Amin, A. G. F., Alhady, A., Abd Alaziz, A., Ali, H. F., & El-Moatasem, A. M. J. I. J. o. M. A. (2023). Effect of Intra-Thoracic Oscillations on Blood Gases after Coronary Artery Bypass Graft Surgery. 5(11), 3848-3854. https://doi.org/10.21608/ijma.2023.235023.1804

Bahodirovich, E. B. J. A. j. o. p., & research, b. (2023). Arrhythmias in patients with cancer. 12(1).

Ben-Nun, L. Clinical Significance of Palpitations.

Calvert, P., & Gupta, D. J. F. C. (2024). Intranasal etripamil for rapid treatment of paroxysmal supraventricular tachycardia. 20(3), 163-170. https://doi.org/10.1080/14796678.2024.2342651

Dye, C. A., Engelstein, E., Swearingen, S., Murphy, J., Larsen, T. J. T. r. o. s. i. c. a., & death, s. c. (2023). arrhythmias and sudden cardiac. 63. https://doi.org/10.3389/fcvm.2022.987247

Hope, A. R. (2024). Modifying the First-Line Treatment of Supraventricular Tachycardia. The University of Arizona. https://doi.org/10.1016/j.annemergmed.2023.10.017

Karcıoğlu, Ö. (2022). Recognition and Management of Supraventricular Arrhythmias and Atrial Fibrillation in the Acute Setting. In Atrial Fibrillation-Diagnosis and Management in the 21st Century: IntechOpen. https://doi.org/10.5772/intechopen.106182

Környei, L. (2023). Incidence and Potential Prevention of Life-Threatening Ventricular and supraventricular tachyarrhythmias in children.

Lu, Z., Zhu, J., Gao, M., Song, Q., Pan, D., Huang, C., . . . Shen, Y. J. J. o. I. M. R. (2024). Efficacy and safety of modified Valsalva maneuver for treatment of paroxysmal supraventricular tachycardia: a meta-analysis. 52(1), 03000605231220871. https://doi.org/10.1177/03000605231220871

Moore, K. G., & Howell, M. M. Foundations of Emergency Medicine.

Muñoz-Ortiz, E., Miranda-Arboleda, A. F., Saavedra-González, Y. A., Gándara-Ricardo, J. A., Velásquez-Penagos, J., Giraldo-Ardila, N., . . . Senior-Sanchez, J. M. J. R. P. d. C. (2024). Characterization of cardiac arrhythmias and maternal–fetal outcomes in pregnant women: A prospective cohort study. 43(2), 67-74. https://doi.org/10.1016/j.repc.2023.08.003

Peng, G., & Zei, P. C. J. J. (2024). Diagnosis and management of paroxysmal supraventricular tachycardia. 331(7), 601-610. https://doi.org/10.1001/jama.2024.0076

Sadek, E. H., Elhay, A., & Azouz, H. J. P. S. S. J. o. N. (2024). Effectiveness of Valsalva Maneuver on Pain Intensity and Anxiety in Children Undergoing Hemodialysis. 11(3), 112-141. https://doi.org/10.21608/pssjn.2024.269654.1298

Shoukat, R., Ahmad, S., Jehangir, H. M. S., Arshad, W., Shah, Z. H., Ahmad, T. J. P. J. o. M., & Sciences, H. (2023). Comparing Efficacy of Standard Vs Modified Valsalva Maneuver in Terminating Paroxysmal Supraventricular Tachycardia. 17(04), 170-170. https://doi.org/10.53350/pjmhs2023174170

Ślusarczyk, K. J., Kasperowicz, J. M., Gałuszka, D. M., Wilk, M., Kocięba-Łaciak, A., & Blicharz, P. J. A. B. (2023). The Effectiveness of Physical Maneuvers in the Conversion of Supra-Ventricular Tachycardia on the Example of the Valsalva’s Maneuver. 65(5). https://doi.org/10.36740/abal202305113

Stambler, B. S., Camm, A. J., Alings, M., Dorian, P., Heidbuchel, H., Houtgraaf, J., . . . Piccini, J. P. J. T. L. (2023). Self-administered intranasal etripamil using a symptom-prompted, repeat-dose regimen for atrioventricular-nodal-dependent supraventricular tachycardia (RAPID): a multicentre, randomised trial. 402(10396), 118-128. https://doi.org/10.1016/s0735-1097(24)02174-0

Tzeis, S., Gerstenfeld, E. P., Kalman, J., Saad, E., Shamloo, A. S., Andrade, J. G., . . . Calkins, H. J. H. r. (2024). European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. 1-128.

Zeng, L., Yu, J., Chen, R., Yang, H., Li, H., Zeng, L., . . . Chen, K. J. F. i. N. (2023). Modified Valsalva maneuver after burr-hole drainage of chronic subdural hematomas: A single-center cohort study. 13, 1069708. https://doi.org/10.3389/fneur.2022.1069708