Modified Valsalva Maneuver Increases Conversion of Paroxysmal Supraventricular Tachycardia

Paroxysmal supraventricular tachycardia (PSVT) is treated with vagal maneuvers, including the Valsalva maneuver, followed by medication or electrical cardioversion if vagal maneuvers are unsuccessful. Turkish investigators performed a randomized, controlled trial comparing the standard Valsalva maneuver with a previously described modified Valsalva maneuver in 56 patients with PSVT (NEJM JW Emerg Med Oct 2015 and Lancet 2015; 386:1747.)

In the standard group (control), the seated patient was asked to blow into the tip of a 10-mL syringe for 15 seconds, hard enough to move the plunger. In the modified group (experimental), the same procedure was used but was followed by quickly bringing the patient to a supine position and then lifting the pa…