Abstract
BackgroundSupraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in terminating SVT episodes. We aimed to compare the standard VM (SVM) to the modified valsalva maneuver (MVM). We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department.MethodsIn this systematic review and meta-analysis, we searched Medline/PubMed, Ovid, Web of Science, and Cochrane Central Register of Controlled trials. We included only randomized controlled trials (RCTs) that compared the modified valsalva to the standard valsalva maneuver in treating SVT. Our main outcome was the termination of SVT within 1 min.ResultsFour articles met the eligibility criteria of our review. Sinus rhythm was achieved 2.5 times more in the MVM group compared to the SVM group (risk ratio (RR) = 2.54, CI 1.98–3.24, P < 0.001) and thus lowered the need of intravenous SVT termination medication without any significant increase in adverse events or time spent in the emergency department.ConclusionOur review found MVM to be more effective than the SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.
Highlights
Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy
Vagal maneuvers are recommended as a first-line modality for terminating supraventricular tachycardia (SVT) in the emergency department (ED) with the standard valsalva maneuver (SVM) being most commonly used [1]
Trial characteristics The four included randomized controlled trials (RCTs) enrolled 787 participants with SVT in which standard VM (SVM) was used in 394 participants and modified valsalva maneuver (MVM) used in the remaining 393, all included in the meta-analysis
Summary
Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in terminating SVT episodes. We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department. Vagal maneuvers are recommended as a first-line modality for terminating supraventricular tachycardia (SVT) in the emergency department (ED) with the standard valsalva maneuver (SVM) being most commonly used [1]. Given the introduction of 787 participants, we aimed to perform a systematic review and meta-analysis comparing the efficacy SVM and MVM in the termination of SVT in ED with respect to sinus rhythm restoration within 1 min, the need for emergency antiarrhythmic treatment, and time in spent in ED
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