Efficacy of Modified versus Standard Valsalva Manoeuvre for Treating Supraventricular Tachycardia in an Emergency Department: A Quasi-Experiment

Abstract

Objective: To assess efficacy of modified Valsalva manoeuvre in comparison to standard Valsalva manoeuvre
in treating Supraventricular tachycardia in an emergency department.
Methods: It was a quasi–experiment conducted in Azra Naheed Medical College Lahore including 132
patients presented with supraventricular tachycardia (SVT) in an emergency department. Patients were
equally divided and randomly assigned to receive standard Valsalva manoeuvre and modified Valsalva
manoeuvre. ECG was recorded before and after the Manoeuvre. Subjects reverted back to sinus rhythm
within one minute of allocated manoeuvre were considered successful. SPSS version 21 was used to manage
and analyze data.
Results: Mean age of participants was 40±11 years with 33% male and 66% were females. Mean duration of
paroxysmal SVT in participants was 5 ± 4 years. The mean systolic and diastolic blood pressure was 112±15
and 72±10 mmHg respectively. The range of pulse rate per minute was from 136 to 240 with a mean of 184 ±
24. SVT was reverted by Valsalva Manoeuvre in 89 (67.4%) patients and did not revert by these Manoeuvers
in 43 (32.6%) patients. Out of 89 reverted, 38 were reverted by performing Standard Valsalva method and 51
were reverted by performing modified Valsalva methods (p=0.025). There was no association between age,
sex, duration of SVT, presence of Diabetes Mellitus, Hypertension or Ischemic Heart Disease with the
effectiveness of Vagal Manoeuvre for termination to sinus rhythm.
Conclusion: Modified Valsalva manoeuvre is significantly effective than the standard manoeuvre in
terminating SVT without increasing adverse effects or time spent in the emergency department.
Keywords: Modified Valsalva Manoeuvre, Standard Valsalva Manoeuvre, Supraventricular Tachycardia