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Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia.

Abstract

BACKGROUND

Patients with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of AV nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents or electrical cardioversion. A commonly used first-line technique to restore the normal sinus rhythm (reversion) is the Valsalva Manoeuvre (VM). This is a non-invasive means of increasing myocardial refractoriness by increasing intrathoracic pressure for a brief period, thus stimulating baroreceptor activity in the aortic arch and carotid bodies, resulting in increased parasympathetic (vagus nerve) tone.

OBJECTIVES

To assess the evidence of effectiveness of the Valsalva Manoeuvre in terminating supraventricular tachycardia.

SEARCH METHODS

We electronically searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 1 of 12, 2012); MEDLINE Ovid (1946 to January 2012); EMBASE Ovid (1947 to January 2012); Web of Science (1970 to 27 January 2012); and BIOSIS Previews (1969 to 27 January 2012). Trials registries, the Index to Theses and the bibliographies of all relevant publications identified by these strategies were also checked.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs) that examined the effectiveness of the Valsalva Manoeuvre in terminating SVT.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data using a standardised form. Each trial was assessed for internal validity with differences resolved by discussion. Data were then extracted and entered into Review Manager 5.1 (RevMan).

MAIN RESULTS

We identified three randomised controlled trials including 316 participants. All three studies compared the effectiveness of VM in reverting SVT with that of other vagal manoeuvres in a cross-over design. Two studies induced SVT within a controlled laboratory environment. Participants had ceased all medications prior to engaging in these studies. The third study reported on patients presenting to a hospital emergency department with an episode of SVT. These patients were not controlled for medications or other factors prior to intervention.The two laboratory studies demonstrated reversion rates of 45.9% and 54.3%, whilst the clinical study demonstrated reversion success of 19.4%. This discrepancy may be due to methodological differences between studies, the effect of induced SVT versus spontaneous episodic SVT, and participant factors such as medications and comorbidities. We were unable to assess any of these factors further, nor adverse effects, since they were either not described in enough detail or not reported at all.Statistical pooling was not possible due to heterogeneity between the included studies.

AUTHORS' CONCLUSIONS

We did not find sufficient evidence to support or refute the effectiveness of the Valsalva Manoeuvre for termination of SVT. Further research is needed and this should include a standardised approach to performance technique and methodology.

Authors+Show Affiliations

Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. gavin.smith@monash.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

23543578

Citation

Smith, Gavin D., et al. "Effectiveness of the Valsalva Manoeuvre for Reversion of Supraventricular Tachycardia." The Cochrane Database of Systematic Reviews, 2013, p. CD009502.
Smith GD, Dyson K, Taylor D, et al. Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia. Cochrane Database Syst Rev. 2013.
Smith, G. D., Dyson, K., Taylor, D., Morgans, A., & Cantwell, K. (2013). Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia. The Cochrane Database of Systematic Reviews, (3), CD009502. https://doi.org/10.1002/14651858.CD009502.pub2
Smith GD, et al. Effectiveness of the Valsalva Manoeuvre for Reversion of Supraventricular Tachycardia. Cochrane Database Syst Rev. 2013 Mar 28;(3)CD009502. PubMed PMID: 23543578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia. AU - Smith,Gavin D, AU - Dyson,Kylie, AU - Taylor,David, AU - Morgans,Amee, AU - Cantwell,Kate, Y1 - 2013/03/28/ PY - 2013/4/2/entrez PY - 2013/4/2/pubmed PY - 2013/7/16/medline SP - CD009502 EP - CD009502 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 3 N2 - BACKGROUND: Patients with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of AV nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents or electrical cardioversion. A commonly used first-line technique to restore the normal sinus rhythm (reversion) is the Valsalva Manoeuvre (VM). This is a non-invasive means of increasing myocardial refractoriness by increasing intrathoracic pressure for a brief period, thus stimulating baroreceptor activity in the aortic arch and carotid bodies, resulting in increased parasympathetic (vagus nerve) tone. OBJECTIVES: To assess the evidence of effectiveness of the Valsalva Manoeuvre in terminating supraventricular tachycardia. SEARCH METHODS: We electronically searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 1 of 12, 2012); MEDLINE Ovid (1946 to January 2012); EMBASE Ovid (1947 to January 2012); Web of Science (1970 to 27 January 2012); and BIOSIS Previews (1969 to 27 January 2012). Trials registries, the Index to Theses and the bibliographies of all relevant publications identified by these strategies were also checked. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that examined the effectiveness of the Valsalva Manoeuvre in terminating SVT. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data using a standardised form. Each trial was assessed for internal validity with differences resolved by discussion. Data were then extracted and entered into Review Manager 5.1 (RevMan). MAIN RESULTS: We identified three randomised controlled trials including 316 participants. All three studies compared the effectiveness of VM in reverting SVT with that of other vagal manoeuvres in a cross-over design. Two studies induced SVT within a controlled laboratory environment. Participants had ceased all medications prior to engaging in these studies. The third study reported on patients presenting to a hospital emergency department with an episode of SVT. These patients were not controlled for medications or other factors prior to intervention.The two laboratory studies demonstrated reversion rates of 45.9% and 54.3%, whilst the clinical study demonstrated reversion success of 19.4%. This discrepancy may be due to methodological differences between studies, the effect of induced SVT versus spontaneous episodic SVT, and participant factors such as medications and comorbidities. We were unable to assess any of these factors further, nor adverse effects, since they were either not described in enough detail or not reported at all.Statistical pooling was not possible due to heterogeneity between the included studies. AUTHORS' CONCLUSIONS: We did not find sufficient evidence to support or refute the effectiveness of the Valsalva Manoeuvre for termination of SVT. Further research is needed and this should include a standardised approach to performance technique and methodology. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/23543578/Effectiveness_of_the_Valsalva_Manoeuvre_for_reversion_of_supraventricular_tachycardia_ L2 - https://doi.org/10.1002/14651858.CD009502.pub2 DB - PRIME DP - Unbound Medicine ER -