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Cochrane Database of Systematic Reviews

Efectividad de la maniobra de Valsalva para la reversión de la taquicardia supraventricular

Information

DOI:
https://doi.org/10.1002/14651858.CD009502.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 18 February 2015see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Heart Group

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Gavin D Smith

    Correspondence to: College of Health and Biomedicine (Paramedicine), Victoria University, St Albans, Australia

    [email protected]

    [email protected]

  • Meagan M Fry

    Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine (Paramedicine), Victoria University, St Albans, Australia

  • David Taylor

    Emergency Medicine, Austin Health, Heidelberg, Australia

  • Amee Morgans

    Department of Primary Health Care, Monash University, Clayton, Australia

  • Kate Cantwell

    Epidemiology and Preventative Medicine, Monash University, Prahan, Australia

Contributions of authors

Gavin D Smith, Meagan M Fry, and Amee Morgans: data search, data acquisition, data filtering, preparation of final report, and update of review

Gavin D Smith, Meagan M Fry, David Taylor, Amee Morgans, and Kate Cantwell: data analysis

Declarations of interest

Kate Cantwell and Gavin D Smith declare that they were employees of Ambulance Victoria at the time this review was conducted. The remaining review authors declare no interest, financial or otherwise, in the completion, conduct, or outcomes of this review.

Acknowledgements

Sharon Kramer, Systematic Review Trainer, Australasian Cochrane Centre, for her invaluable assistance in guiding the review authors through the review process.

Version history

Published

Title

Stage

Authors

Version

2015 Feb 18

Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia

Review

Gavin D Smith, Meagan M Fry, David Taylor, Amee Morgans, Kate Cantwell

https://doi.org/10.1002/14651858.CD009502.pub3

2013 Mar 28

Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia

Review

Gavin D Smith, Kylie Dyson, David Taylor, Amee Morgans, Kate Cantwell

https://doi.org/10.1002/14651858.CD009502.pub2

2011 Dec 07

Effectiveness of the Valsalva Manoeuvre for reversion of supra‐ventricular tachycardia in the prehospital and emergency medicine settings

Protocol

Gavin D Smith, Kylie Dyson, David Taylor, Amee Morgans, Anna Holdgate, Kate Cantwell

https://doi.org/10.1002/14651858.CD009502

Differences between protocol and review

As we identified no RCT studies with participants older than 18 years only, we unanimously decided that the protocol should be varied to enable inclusion of those studies that included paediatric participants in order to enable this review to report what is currently known.

Due to the nature of RCT studies included in this review, it was necessary to change both the title and objectives of the review to remove the terminology "in the prehospital and emergency medicine settings" to more appropriately reflect what we could assess from the published evidence.

The adverse effects search strategy differs between protocol and review. Because the VM is used as a therapeutic and diagnostic tool across many scientific and medical disciplines, we needed to change the adverse effects search strategy in order to refine the results to VM application to the SVT setting.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

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Adverse events search results.
Figures and Tables -
Figure 2

Adverse events search results.

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Summary of findings for the main comparison. Summary of findings ‐ induced SVT

Valsalva Manoeuvre for induced supraventricular tachycardia

Patient or population: People with induced SVT

Settings: Clinical laboratory

Intervention: VM

Comparison: Nil

Outcomes

Study

VM Performance

(posture, strain duration, pressure)

Reversion n (%)

Quality of the evidence
(GRADE)

Reversion

Mehta 1988

Supine, 15 and 30 seconds*, 35 mmHg

19/35 (54.3)

⊕⊕⊝⊝
low

Wen 1998

Supine, 30 seconds, 35 mmHg

61/133 (45.9)

⊕⊕⊝⊝
low

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

*Although applying both 15‐ and 30‐second strain durations, the Mehta study found no statistical significance of bradycardia effect (increased vagal tone) on participants when assessed in sinus rhythm.

Abbreviations:

SVT: supraventricular tachycardia

VM: Valsalva Manoeuvre
Figures and Tables -
Summary of findings for the main comparison. Summary of findings ‐ induced SVT
Navigate to table in Review
Summary of findings 2. Summary of findings ‐ clinical SVT

Valsalva Manoeuvre for clinical supraventricular tachycardia (patients presenting with arrhythmia)

Patient or population: Patients presenting to emergency department with SVT

Settings: Emergency department (hospital)

Intervention: VM

Comparison: Nil

Outcomes

Study

VM Performance
(posture, strain duration, pressure)

Reversion n (%)

Quality of the evidence
(GRADE)

Reversion

Lim 1998

Sitting*, 30 seconds, 40 mmHg

12/62 (19.4)

⊕⊕⊝⊝
low

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

*Although a deviation from accepted standard of performance technique, this posture is acceptable as a known method of performance in the clinical setting. Also, this posture has been demonstrated to precipitate adverse effects. The absence of reported adverse effects (such as hypotension or syncope) is not clear within the study.

Abbreviations:

SVT: supraventricular tachycardia

VM: Valsalva Manoeuvre
Figures and Tables -
Summary of findings 2. Summary of findings ‐ clinical SVT
Navigate to table in Review