Modified Valsalva Maneuver for Supraventricular Tachycardia

The Valsalva maneuver is recommended first-line treatment for stable patients with supraventricular tachycardia, although it is successful in only a minority of patients. These authors tested whether a modified Valsalva maneuver can improve cardioversion rates.

In a randomized, controlled trial, 433 patients who presented to 10 U.K. emergency departments (EDs) with supraventricular tachycardia (not including atrial fibrillation or flutter) performed a standard Valsalva maneuver (15-second, 40-mm Hg strain while in a semirecumbent position) either alone or followed immediately by supine repositioning (by reclining the head of the bed) and passive leg raise to 45 degrees. Each maneuver was repeated once for patients who did not convert.

Among t…