Efficacy of Modified Valsalva Maneuver Versus Standard Valsalva Maneuver in The Termination of Paroxysmal Supraventricular Tachycardia: A Single Center Study


  • Alhassan Dhurgham Hamzah M.B.Ch.B
  • Hasan Ali Ajeel M.B.Ch.B
  • Naqaa Majeed Hameed Al-Sayagh M.B.Ch.B


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
Those who did not respond to non-pharmacological measures were treated with pharmacological
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


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