Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial

Am J Emerg Med. 2017 Nov;35(11):1662-1665. doi: 10.1016/j.ajem.2017.05.034. Epub 2017 May 22.


Purpose: The study aimed to detect whether modified Valsalva maneuver (VM) is more effective than the standard VM in terminating paroxysmal supraventricular tachycardia (PSVT).

Methodology: This randomized controlled trial was conducted in the emergency department of a training and research hospital between Dec. 1, 2015 and Dec. 31, 2016. Participants were divided into two groups, randomly assigned standard VM or modified VM, as the first treatment with two-dimensional permutation blocks; in the order of arrival of the patients. In both groups; the determined procedure for standard or modified VM was repeated up to three times in patients whose PSVT did not convert to sinus rhythm. In both groups; if the maneuver was unsuccessful after three attempts, anti-arrhythmic medication was administered. The primary outcome was defined to compare the success rate of achieving sinus rhythm after standard VM or modified VM.

Results: Fifty-six patients were randomized to modified or standard VM with 28 patients in each treatment arm. Three of 28 patients (10.7%) in VM group and 12 of 28 patients (42.9%) in modified VM group were returned to sinus rhythm after intervention (p=0.007). The number of patients who needed rescue treatment was lower in the modified VM group - 16 (57.1%) of 28 versus 25 (89.3%) of 28 in the standard VM group (p=0.007).

Conclusion: This study suggests that modified VM therapy was more effective than standard VM for terminating PSVT. The modified VM therapy also indirectly reduced the need for anti-arrhythmic medication and indirectly caused fewer side effects.

Keywords: Emergency department; Modified Valsalva maneuver; Standard Valsalva maneuver; Supraventricular tachycardia.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anti-Arrhythmia Agents / therapeutic use
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Middle Aged
  • Tachycardia, Paroxysmal / therapy*
  • Tachycardia, Supraventricular / therapy*
  • Treatment Outcome
  • Valsalva Maneuver*


  • Anti-Arrhythmia Agents