Efficacy of the modified Valsalva maneuver as a treatment for reversing supraventricular tachycardia: systematic review
DOI:
https://doi.org/10.11606/issn.1679-9836.v100i2p171-177Keywords:
Tachycardia, Modified Valsalva maneuver, Vagal maneuver, Adenosine, Electric countershockAbstract
ntroduction: supraventricular tachycardia is a frequent arrhythmia with prevalence of 2.29 per 1000 people. Medical and electrical treatments are already written in guidelines such as those of the American Heart Association, however, accompanied by a risk of side effects such as shortness of breath and chest the compression sensation. Non-drug stimulation of the vagus nerve, such as the conventional Valsalva maneuver, has little side effect, however, low efficiency with about 17% of conversions. In this scenario, a new method of parasympathetic stimulation has been promising in the initial non-drug therapy: the modified Valsalva maneuver. This consists of the elevation of the lower limbs after expiration against resistance, in order to achieve a greater degree of vagal stimulation. Objective: to evaluate the success rate in the reversion of supraventricular tachycardia by the modified maneuver, analyzing the results of the execution of this maneuver, as well as comparing it with the conventional Valsalva maneuver. Methodology: searches were made in the Scielo and PubMed database using the terms “tachycardia AND modified Valsalva maneuver”. Articles published from 2005 to 2020 were selected and passed by an individual filtering of their contents (title, abstract and methodologies) to homogenize the results. Results and Discussion: the article presented by Scielo did not match this type of study, and among the 29 listed by PubMed, after filtering time and criteria for individual analysis, 9 articles were compiled in this review, 3 of which make a teaching assessment of the modified maneuver while 6 demonstrate a direct comparison between the maneuvers. All point to greater efficiency in cardioversion of arrhythmia by the modified maneuver compared to a conventional one, with an average of the resolution percentages of 48.3% against 19.6%, respectively, with no significant differences in adverse events. Conclusion: The modified Valsalva maneuver generated a greater reversion of the arrhythmia than who used a conventional one, with no added effects and exposing fewer patients to drug therapies or electrical cardioversions.
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