Article Sidebar

Submitted
April 25, 2024
Accepted
April 25, 2024
Published
April 28, 2024
Download
PDF
Statistic
Read Counter : 568 Download : 435

Main Article Content

Abstract

Background: Supraventricular tachycardia is a common disturbance in the cardiac rhythm that
originates above the cardiac ventricles, and include various forms like atrial fibrillation, atrial
flutter, and others, as well as the paroxysmal form which is called paroxysmal supraventricular
tachycardia that denotes a subset of supraventricular tachycardia that present in form of rapid
regular tachycardia with a sudden onset and offset like atrioventricular nodal reentrant tachycardia,
atrioventricular reentrant tachycardia, and atrial tachycardia. Management involves either nonpharmacological measures (vagal maneuvers) or pharmacological treatment. The Valsalva
maneuver is considered a simple non-invasive measure for induction of increased vagal tone, with
certain modifications are performed in order to increase venous return of relaxation phase.
Aim of the Study: To compare between the efficacy of modified Valsalva maneuver versus
standard Valsalva maneuver in the termination of paroxysmal supraventricular tachycardia.
Methodology: This study is a randomized controlled trial conducted in the coronary care unit of
Al-Hussein medical city – Kerbela during the period from January 2019 to January 2020, and
included 103 patients presented with paroxysmal supraventricular tachycardia, who were subjected
to either modified Valsalva maneuver or standard Valsalva maneuver, with documentation of the
response.
Those who did not respond to non-pharmacological measures were treated with pharmacological
treatment.
Results: Mean age of participants was (49.60 ± 11.88) years, females comprised 61.17% of them.
Patients treated with modified Valsalva maneuver had significantly higher positive response
compared to patients treated with standard Valsalva maneuver, with a P-value of 0.003 and odds
ratio of 4.7 (CI 95%).
Response was significantly higher among males (P-value = 0.001) and significantly lower among
long standing diabetic patients (P-value = 0.009).
All patients who had no response to non-pharmacological measures were treated successfully with
pharmacological therapy.
Conclusions: modified Valsalva maneuver was significantly more effective than standard
Valsalva maneuver in termination of paroxysmal supraventricular tachycardia. Males were better
responder than females. Long standing diabetic patients had poor response

Article Details

License

Copyright (c) 2024 University of Thi-Qar Journal Of Medicine

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Smith G, Fry M, Taylor D, Morgans A, Cantwell K. Effectiveness of the Valsalva Manoeuvre for
  2. reversion of supraventricular tachycardia. The Cochrane Library. 2015;2:1-24.
  3. Sohinki D, Obel O. Current Trends in Supraventricular Tachycardia Management. The Ochsner
  4. Journal. 2014;14:586-595.
  5. Antzelevitch Ch. Basic mechanisms of reentrant arrhythmias. Current Opinion in Cardiology.
  6. ;16:1-7.
  7. Antzelevitch Ch, Burashnikov A. Overview of Basic Mechanisms of Cardiac Arrhythmia. Cardiac
  8. Electrophysiology Clinics. 2011;3(1):23-45.
  9. Bibas L, Levi M, Essebag V. Diagnosis and management of supraventricular tachycardias. Canadian
  10. Medical Association Journal. 2016;188(17-18):E466-E473.
  11. Papadakis M, McPhee S, Rabow M. CURRENT Medical Diagnosis and Treatment 2020. 59th ed.
  12. McGraw Hill Professional; 2019.
  13. Medi C, Kalman J, Freedman S. Supraventricular Tachycardia. The Medical Journal of Australia.
  14. ;190(5):255-260.
  15. Hagopian R, O’Keefe-Baker V, Aziz Z, Beaser A, Nayak H. Malignant atrioventricular nodal reentry
  16. tachycardia resulting in cardiac arrest. Heart Rhythm Case Reports. 2019;5(3):173-175.
  17. Jameson J, Kasper D, Fauci A, Hauser S, Longo D, Loscalzo J et al. Harrison's principles of internal
  18. medicine. 20th ed. McGraw Hill Professional; 2018.
  19. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ et al. European
  20. Society of Cardiology Committee, NASPE-Heart Rhythm Society. ACC/AHA/ESC guidelines for the
  21. management of patients with supraventricular arrhythmias--executive summary. a report of the American college
  22. of cardiology/American heart association task force on practice guidelines and the European society of
  23. cardiology committee for practice guidelines (writing committee to develop guidelines for the management of
  24. patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society.
  25. Journal of the American College of Cardiology. 2003;42(8):1493-1531.
  26. Page R, Joglar J, Caldwell M, Calkins H, Conti J, Deal B et al. 2015 ACC/AHA/HRS Guideline for
  27. the Management of Adult Patients With Supraventricular Tachycardia. Journal of the American College of
  28. Cardiology. 2015;67(13).
  29. Brubaker S, Long B, Koyfman A. Alternative Treatment Options for Atrioventricular-Nodal-Reentry
  30. Tachycardia: An Emergency Medicine Review. The Journal of Emergency Medicine. 2018;54(2):198–206.
  31. Ferguson J, DiMarco J. Contemporary Management of Paroxysmal Supraventricular Tachycardia.
  32. Circulation. 2003;107:1096-1099.
  33. Smith G. Management of supraventricular tachycardia using the Valsalva manoeuvre: a historical
  34. review and summary of published evidence. European Journal of Emergency Medicine. 2012;19(6):346-352.
  35. Felker G, Cuculich Ph, Gheorghiade M. The Valsalva Maneuver: A Bedside “Biomarker” for Heart
  36. Failure. The American Journal of Medicine. 2006;119:117-122.
  37. Junqueira L. Teaching cardiac autonomic function dynamics employing the Valsalva (ValsalvaWeber) maneuver. Advances in Physiology Education. 2008;32:100-106.
  38. Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A et al. Postural modifi cation to the
  39. standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a
  40. randomised controlled trial. Lancet. 2015;386:1747-1753.
  41. Campbell M, Buitrago S. BET 2: Ice water immersion, other vagal manoeuvres or adenosine for SVT
  42. in children. Emergency Medicine Journal. 2016;34(1):58-60.
  43. Ceylan E, Ozpolat C, Onur O, Akoglu H, Denizbasi A. Initial and Sustained Response Effects of 3
  44. Vagal Maneuvers in Supraventricular Tachycardia: A Randomized, Clinical Trial. The Journal of Emergency
  45. Medicine. 2019;57(3):299-305.
  46. Brachmann J, Lewalter T, Kuck K, Andersen D, Willems S, Spitzer S et al. Long-term symptom
  47. improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from
  48. the German ablation registry. European Heart Journal. 2017;38(17):1317-1326.
  49. Strieper M, Frias P, Fischbach P, Costello L, Campbell R. Catheter Ablation of Primary
  50. Supraventricular Tachycardia Substrate Presenting as Atrial Fibrillation in Adolescents. Congenital Heart
  51. Disease. 2010;5(5):465-469.
  52. Mohammad AM, Saeed MS, Migliore F. Effectiveness of the modified valsalva maneuver in the
  53. emergency management of supraventricular tachycardia. Medical Journal of Babylon 2019;16:104-107.
  54. Abdulqadir DF, Ahmed HF, Ismaeel SM. Response of supraventricular tachycardia patients to
  55. modified Valsalva maneuver in Rozhalat emergency hospital/Erbil city – Kurdistan region of Iraq. Medical
  56. Journal of Babylon 2019;16:261-264.
  57. Corbacioglu S, Akinci E, Cevik Y, Aytar H, Oncul M, Akkan S et al. Comparing the success rates of
  58. standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial. The American
  59. Journal of Emergency Medicine. 2017;35(11):1662-1665.
  60. Boulton A, Vinik A, Arezzo J et al. Diabetic Neuropathies: A statement by the American Diabetes
  61. Association. Diabetes Care. 2005;28(4):956–962.
  62. Vinik A. Casellini C, Parson H, Colberg Sh, Nevoret M. Cardiac Autonomic Neuropathy in Diabetes:
  63. A Predictor of Cardiometabolic Events. Frontiers in Neuroscience. 2018;12:59

Most read articles by the same author(s)