Modified vs Standard Valsalva Maneuver Superior for SVT Conversion to Sinus Rhythm

Researchers compared the modified Valsalva maneuver to the standard method to assess efficacy and safety for converting SVT to sinus rhythm.

A modified Valsalva maneuver (MVM) was found to be more effective than the standard Valsalva maneuver (SVM) for converting patients from supraventricular tachycardia (SVT) to sinus rhythm, according to a systematic review and meta-analysis published in the American Journal of Emergency Medicine.

Researchers from Lanzhou University in China searched publication databases through June 2021 for studies on Valsalva maneuver methods in order to return patients to sinus rhythm. A total of 6 randomized clinical trials were included in this analysis.

There were 1208 patients included, 603 of whom received an SVM and 605 an MVM approach. Studies were conducted in Turkey (n=2), China (n=2), Egypt (n=1), and the United Kingdom (n=1), and sample sizes ranged between 28 and 214 individuals.

The primary outcome was the success rate of achieving sinus rhythm. MVM was found to be more effective than SVM for conversion to sinus rhythm (relative risk [RR], 2.92; 95% CI, 2.52-3.38; P <.00001) with no evidence of study heterogeneity (I2, 0%; P =.92).

Termination of SVT was more effective by a single MVM (RR, 2.83; 95% CI, 2.19-3.66; P <.00001), multiple MVM (RR, 3.83; 95% CI, 2.26-6.50; P <.00001), and single or multiple MVM (RR, 2.85; 95% CI, 2.35-3.45; P <.00001) compared with single, multiple, and single or multiple SVM, respectively.

Among secondary outcomes, MVM was associated with decreased use of verapamil or adenosine (RR, 0.69; 95% CI, 0.61-0.78; P <.00001) and emergency anti-arrhythmic drugs (RR, 0.70; 95% CI, 0.62-0.79; P <.00001).

MVM did not decrease length of stay in the emergency department (RR, 0.03; 95% CI, -0.17 to 0.23; P =.79) or risk for adverse events (RR, 1.48; 95% CI, 0.91-2.42; P =.11).

This study was limited by the lack of standardization with regard to the duration of pressure during Valsalva maneuver procedures.

The data indicated that for patients who present with SVT at emergency departments, an MVM would likely be more effective than SVM for returning the patients to sinus rhythm.

“Using MVM also reduced the use of other anti-arrhythmic methods and drugs (adenosine/verapamil), and indirectly reduced the adverse events caused by VM and anti-arrhythmic methods or drugs,” the researchers noted. “Therefore, for patients with SVT and emergency doctors, using MVM at home or in the ED can quickly and safely terminate the onset of SVT, so as to reduce the medical burden of patients and the consumption of medical resources.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Lan Q, Han B, Wu F, Peng Y, Zhang Z. Modified Valsalva maneuver for treatment of supraventricular tachycardias: a meta-analysis. Am J Emerg Med. 2021;50:507-512. doi:10.1016/j.ajem.2021.08.067