Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia
Appendices
Appendix 1. Primary search strategy
CENTRAL
#1 MeSH descriptor Valsalva Maneuver, this term only
#2 (valsalva*)
#3 MeSH descriptor Vagus Nerve explode all trees
#4 (vagal)
#5 MeSH descriptor Vagus Nerve Stimulation, this term only
#6 (vagus)
#7 (#1 OR #2 OR #3 OR #4 OR #5 OR #6)
#8 MeSH descriptor Tachycardia, Supraventricular explode all trees
#9 MeSH descriptor Tachycardia, Paroxysmal, this term only
#10 MeSH descriptor Tachycardia, Reciprocating explode all trees
#11 (supraventric* near/4 arrhythmi*)
#12 (supra‐ventric* near/4 arrhythmi*)
#13 (tachyarrhythmi*)
#14 (svt)
#15 (avrt)
#16 (avnrt)
#17 (tachycardi*)
#18 (#8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17)
#19 (#7 AND #18)
MEDLINE OVID
1 Valsalva Maneuver/
2 valsalva*.tw.
3 exp Vagus Nerve/
4 vagal.tw.
5 Vagus Nerve Stimulation/
6 vagus.tw.
7 or/1‐6
8 exp Tachycardia, Supraventricular/
9 Tachycardia, Paroxysmal/
10 exp Tachycardia, Reciprocating/
11 (supraventric* adj4 arrhythmi*).tw.
12 (supra‐ventric* adj4 arrhythmi*).tw.
13 tachyarrhythmi*.tw.
14 svt.tw.
15 avrt.tw.
16 avnrt.tw.
17 tachycardi*.tw.
18 or/8‐17
19 7 and 18
20 randomized controlled trial.pt.
21 controlled clinical trial.pt.
22 randomized.ab.
23 placebo.ab.
24 drug therapy.fs.
25 randomly.ab.
26 trial.ab.
27 groups.ab.
28 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27
29 exp animals/ not humans.sh.
30 28 not 29
31 19 and 30
EMBASE OVID
1 Valsalva Maneuver/
2 valsalva*.tw.
3 exp Vagus Nerve/
4 vagal.tw.
5 Vagus Nerve Stimulation/
6 vagus.tw.
7 or/1‐6
8 exp Tachycardia, Supraventricular/
9 Tachycardia, Paroxysmal/
10 exp Tachycardia, Reciprocating/
11 (supraventric* adj4 arrhythmi*).tw.
12 (supra‐ventric* adj4 arrhythmi*).tw.
13 tachyarrhythmi*.tw.
14 svt.tw.
15 avrt.tw.
16 avnrt.tw.
17 tachycardi*.tw.
18 or/8‐17
19 7 and 18
20 random$.tw.
21 factorial$.tw.
22 crossover$.tw.
23 cross over$.tw.
24 cross‐over$.tw.
25 placebo$.tw.
26 (doubl$ adj blind$).tw.
27 (singl$ adj blind$).tw.
28 assign$.tw.
29 allocat$.tw.
30 volunteer$.tw.
31 crossover procedure/
32 double blind procedure/
33 randomized controlled trial/
34 single blind procedure/
35 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34
36 (animal/ or nonhuman/) not human/
37 35 not 36
38 19 and 37
Web of Science & BIOSIS Previews
# 15 #14 AND #13
# 14 TS=((random* or blind* or allocat* or assign* or trial* or placebo* or crossover* or cross‐over*))
# 13 #12 AND #4
# 12 #11 OR #10 OR #9 OR #8 OR #7 OR #6 OR #5
# 11 TS=(tachycardi*)
# 10 TS=(avnrt)
# 9 TS=(avrt)
# 8 TS=(svt)
# 7 TS=(tachyarrhythmi*)
# 6 TS=(supra‐ventric* near/4 arrhythmi*)
# 5 TS=(supraventric* near/4 arrhythmi*)
# 4 #3 OR #2 OR #1
# 3 TS=(vagus)
# 2 TS=(vagal)
# 1 TS=(valsalva*)
Appendix 2. Primary adverse effects search strategy
MEDLINE (OVID) search strategy filter for adverse effects as per the Loke 2011 method described in the Cochrane Handbook for Systematic Reviews of Interventions:
1. Valsalva Maneuver/
2. valsalva*.tw.
3. exp Vagus Nerve/
4. vagal.tw.
5. Vagus Nerve Stimulation/
6. vagus.tw.
7. or/1‐6
8. exp Tachycardia, Supraventricular/
9. Tachycardia, Paroxysmal/
10. exp Tachycardia, Reciprocating/
11. (supraventric* adj4 arrhythmi*).tw.
12. (supra‐ventric* adj4 arrhythmi*).tw.
13. tachyarrhythmi*.tw.
14. svt.tw.
15. avrt.tw.
16. avnrt.tw.
17. tachycardi*.tw.
18. or/8‐17
19. 7 and 18
20. adverse effects.fs.
21. contraindications.fs.
22. poisoning.fs.
23. toxicity.fs.
24. drug effects.fs.
25. (toxi* adj2 (effect or effects or reaction* or event or events or outcome*)).tw.
26. (adverse* adj2 (effect or effects or reaction* or event or events or outcome*)).tw.
27. (side adj3 (effect or effects)).tw.
28. (adr or adrs).tw.
29. or/20‐28
30. exp animals/ not humans.sh.
31. 29 not 30
32. 19 and 31
33. (2012* or "2013" or 2014*).ed.
34. 32 and 33
Study flow diagram.
Adverse events search results.
| 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 |
| Reversion | Mehta 1988 | Supine, 15 and 30 seconds*, 35 mmHg | 19/35 (54.3) | ⊕⊕⊝⊝ |
| Wen 1998 | Supine, 30 seconds, 35 mmHg | 61/133 (45.9) | ⊕⊕⊝⊝ | |
| GRADE Working Group grades of evidence *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 | ||||
| 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 | Reversion n (%) | Quality of the evidence |
| Reversion | Lim 1998 | Sitting*, 30 seconds, 40 mmHg | 12/62 (19.4) | ⊕⊕⊝⊝ |
| GRADE Working Group grades of evidence *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 | ||||
