Monday, September 23, 2019

Standard vs Modified Valsalva

R.E.B.E.L.EM - September 23, 2019 - By Astin M
"Background: Supraventricular tachycardia (SVT) is not an uncommon condition in the emergency department. Epidemiologically, SVT has an incidence of 35/100,000 person-years in the United States.2That is roughly 89,000 new cases per year. The Valsalva maneuver is a recognized treatment for SVT, but has a low success rate (5-20%). 3,4,5 The REVERT trial showed an increase in cardioversion of SVT using a modified Valsalva maneuver, but this was done with a manometer, and adjustable bed, which may not be available in many settings.
What They Did: The authors conducted a randomized, multicenter parallel group trial in five emergency departments in China. Patients were randomized in a 1:1 fashion to the treatment group or control group.
Author Conclusion: “With this simple modified Valsalva maneuver, the conversion rate of SVT to sinus rhythm was higher than the standard Valsalva maneuver.”
Clinical Take Home Point: Use of a 10 mL syringe and lying the patient supine with 90 degrees of hip flexion can be a useful treatment for SVT, with few adverse effects and no change in ED LOS, if the use of medications or electricity is not desired."